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No. 4804496 Name VERNALI, Concetto 371 Migeon Ave. Torrington, Conn. residing at Age 42 years. Date of order of admission January 14, 1941 Date certificate issued January 14, 1941 by the Superior Court at Winsted, Connecticut Petition No. 4404 AR No. Conscetto Vernah 1664264 (Complete and true signature of holder)

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