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No. 9321192
Name
ZYGNERSKI, Anna
residing at 174 Broad Street, New Britain, Conn.
Date of birth 10/12/18 Date of order of admission 1/7/71
Date certificate issued
January 7, 1971
by the
Superior
Court at
New Britain
Petition No. 8023
Alien Registration No. A13 944 514
Anna (COMPLETE Lygnerski AND TRUE
SIGNATURE OF HOLDER)
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