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No. 8286624 Name MALISZEWSKI, Waleria residing at 89 Heather Lane, New Britain, Conn. Date of birth 9/1/99 Date of order of admission 11/8/62 Date certificate issued November 8, 1962 by the Superior Court at New Britain Petition No. 6733 Alien Registration No. A8 394 270 Walma Malisasuski (COMPLETE AND TRUE SIGNATURE OF HOLDER)

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