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No. 4642602
Name
LAFORCE Marie Seraphine
residing at
96 Main St., Putnam, Conn.,
Age 63 years. Date of order of admission
May 9, 1939
Date certificate issued
May 9, 1939
by the
Superior
Putnam
Court at
Petition No. 2502
Have (Complete and signature of holder) Infusce
Samphne
true
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