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No. 6264841 Name CZARZASTY, MACIEJ Decl XXIK Pg565 rol66-Rg27 residing at 27 Hickory Street, Waterbury, Connecticut Age 56 years. Date of order of admission January 17, 1945 Date certificate issued January 17, 1945 by the Superior Court at Waterbury, Connecticut Petition No. 2277 maing (Complete and true Craizersty signature of holder)

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Document identity
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