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OCR Page 1 of 2No.
7217470
Name ZAKS, Sam
residing at 753 - 12th Ste, San Diego,-Califomia
Date of birth 7/6/98
Date of order of admission 11/4/54
Date certificate issued.
Novembe: I 11, 1954
by the
Superior
Court at San Diego, California
Petition No. 18904
Alien Registration No. 7149735
Dam Zaks
(Compléta and true signature of holder)