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No. 8412577
Name PETERSEN, Borge
residing at RR.#1, Box 221A, Thompson, Connecticut
1925
Date of birth June 23,
Date of order of admission Feb. 6, 1964
Date certificate issued
February 6, 1964
by the
Superior
Court at
Windham, Connecticut
Petition No. 5378
Alien Registration No. A10 071 467
Barge February
(COMPLETE AND TRUE SIGNATURE OF HOLDER)
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