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Furm 3511 46 1883596 Name mendel Kross Age, 26 years Leclaration ofintention. No 4275 sued by District of waterbury onlhe 28 day of march AD1918 Relition, Vil. XIII No . 3219 the 15 day of Dec. 99919 23 Name, age and place of vesidence of wife: James ages and pluces infresident of minor bildren Mind Kra Signature of holder.) An

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