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No. 8773002 Name ZIELINSKI, Michael residing at 447 Arch Street, New Britain, Conn. Date of birth 12/8/15 Date of order of admission 6/16/65 Date certificate issued June 16, 1965 by the Superior Court at New Britain Petition No. 7112 Alien Registration No. A10 926 713 chickael COMPLETE AND TRUE Fielinhi SIGNATURE OF HOLDER)

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