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No. 9013273 Name JANKOWSKI, Angela Maria residing at 61 Smith Street, New Britain, Conn. Date of birth 7/2/48 Date of order of admission 11/7/68 Date certificate issued November 7, 1968 by the Superior Court at New Britain Petition No. 7689 Alien Registration No. AlO 943 639 Angela (COMPLETE AND Maria TRUE SIGNATURE Janbowski OF HOLDER)

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