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No. 7571039 Name WHEATON, Nellie Mary residing at 83 Beaver Street, New Britain, Conn. Date of birth 11/2/10 Date of order of admission 6/17/58 Date certificate issued June 17, 1958 by the Superior Court at New Britain Petition No. 5944 Alien Registration No. Al 090 072 neclie mary Wheaton (Complete and true signature of holder)

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