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No. 7566285 Name ZAVADZKY, Anna residing at 52 Linden Street, New Britain, Conn. Date of birth 7/24/98 Date of order of admission 9/24/57 Date certificate issued September 24, 1957 by the Superior Court at New Britain Petition No. 5737 Alien Registration No. A7 892 514 Anna Lavadeny (Complete and true signature of holder)

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