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No. 7570975 Name WOJCIK, Frank residing at 461 Farmington Ave., New Britain, Conn. Date of birth 12/2/08 Date of order of admission 4/8/58 Date certificate issued April 8, 1958 by the Superior Court at New Britain Petition No. 5896 Alien Registration No. A8 401 265 Fromk Wojeik (Complete and true signature of holder)

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Document identity
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