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No. 4275916 Name GOSSELIN, Ernestine R residing at 459 Main St,, Torrington, Conn. Age 59 years. Date of order of admission Sept. 8, 1937 Date certificate issued Sept. 8, 1937 by the Superior Court at Winsted Petition No. 3682 Ernestme Gosselin (Complete and true signature of holder)

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