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Form 390.
Naportificalle
707606
6
Age 27 years
Name adolf Herner
Declaration No 1304
by District
Court of Conn W tatesbury,
24th day of Oct
Perition, Vol. V No 1062
Order. the daysof
15th
march 09914
Name age und place efuile:
mne
Names, agesand places, of residence, cofminor
children
adult Werner
/Signature of holder.)
New Old centificale. No
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