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No. 4848125
Name ELLIOTT, Sadie Wilhelmina
vollill rg 11
residing at 92 High Street, Waterbury, Connecticut
Age 36
years. Date of order of admission January 20, 1941
Date certificate issued
January 20, 1941
by the
Common Pleas
Court at
Waterbury, Connecticut
Reg. No. 5209408
Petition No. 10951
Sadie Willelminee Elliott E
(Complete and true signature of holder)
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Document identity
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