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No. 8481493
Name
DeANGELIS, Lina Vol.82,Pg.111 82, Pg.
residing at 89 Madison Street, Waterbury, Conn.
Date of birth Jan.23,1941 23, Date of order of admission Apr. 17, 1963
Date certificate issued April 17, 1963
by the
SUPERIOR
Court at WATERBURY, CONNECTICUT
Petition No. 7024
Alien Registration No. A10 921 914
Lina De Angelis
(COMPLETE AND TRUE SIGNATURE OF HOLDER)
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