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No. 7029103 Name HASE, Robert residing at 228 W. Robinson Ave.. San Diego,--Cal. Date of birth 4/1/86 Date of order of admission 1/18/52 Date certificate issued January 21,-1952 by the Superior Court at San Diego, Calif Petition No. 16250 Alien Registration No. 6258218 Robert Rase (Complete and true signature of holder)