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No. 8841761 Name LARAMEE, Lucile Emma residing at 10 Dennis Drive, Thompson, Connecticut Date of birth Aug. 3,1919 Date of order of admission April 23, 1970 Date certificate issued April 23, 1970 by the Superior Court at Putnam, Connecticut Petition No. 5625 Alien Registration No. A14 741 379 Lucile Emma haramee (COMPLETE AND TRUE SIGNATURE OF HOLDER)

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