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No. 9013292 Name WALCZAK, Stanley residing at 23 Beatty Street, New Britain, Conn. Date of birth 5/8/51 Date of order of admission 11/7/68 Date certificate issued November 7, 1968 by the Superior Court at New Britain Petition No. 7714 Alien Registration No. A13 165 634 Stanley (COMPLETE AND Walgak TRUE SIGNATURE OF HOLDER)

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