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No. 8413240
Name PARENT, Jeannette Annette
residing at RFD. #2, Brooklyn, Connecticut
1919
Date of birth Jan. 16, Date of order of admission Nov. 4, 1964
Date certificate issued
November 4, 1964
by the
Superior
Court at Putnam, Connecticut
Petition No. 5427
Alien Registration No. A5 445 986
Jeannette (COMPLETE AND annette TRUE SIGNATURE OF Parent HOLDER)
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