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No. 4009762 R Name SKIBISKY, Alexander residing at 56 East Elm Street, Torrington, Conn. Age 51 years. Date of order of admission Jan. 14, 1936 Date certificate issued Jan. 14, 1936 by the Superior Court at Winsted Petition No. 3512 Glexander (Complete and true signature Skirisky of holder)

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