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FIITIII 3911 711390 40 Name (asimir Roprowski Age, 27 years Declaration ofinlention. No 1883 issued by District Dratestry only 31 day of Octions.,ANDIAN Perition) You. XII No 291 3 the day of June ,9.19 22 Name age, and place offresidence, of wife: suight Names ages, and places, of residence, ofminor children none Rasimni / Signabuy of holder.) Refromeh New Old No

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