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No. 4106951
Name DOLECKI, Wladyslaw vol XLII Pg187
residing at 10 Schultz St. Terryville, Plymouth, Ct.
Age 38 years. Date of order of admission Jan. 15, 1937
Date certificate issued January 15, 1937
by the
Common Pleas
Court at Waterbury, Conn.
Petition No. 8114
Wladystaw (Complete and true bolecki signature of holder)
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