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No. 5428368 Name PAULHUS - ELIZABETH residing at 41 Vandennoort St Putnam, Conn. Age 32 years. Date of order of admission June 17, 1942 Date certificate issued June 17, 1942 by the Superior Court at Putnam, Conn. Petition No. 3130 Eligabeth Paulhns (Complete and true signature of holder)

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