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No. 9587684 R Name GARCIA, Dora residing at 90 East Elm Street, Torrington, Conn. Date of birth Dec. 10, 1924 Date of order of admission Nov. 14, 1972 Date certificate issued November 14, 1972, by the Superior Court at Litchfield, Connecticut, Petition No. 7886 Alien Registration No. All 490 157 Dora Tarcia (COMPLETE AND TRUE SIGNATURE OF HOLDER)

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