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No. 5435741
Name
TRACZYK, Agnes
residing at
267 No. Pine Creek Road, Fairfeld , - Conn.
Age 46
years. Date of order of admission January 15, 1942
Date certificate issued
January 15, 1942
by the
Superior
Court at
Bridgeport, Conn.
Petition No.
26154
Blogszer
Traezyk
(Complete and true signature of holder)
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Document identity
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