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VolIIII ng195
No. 4848261
Name POWELL, George Decl XXIX rg 575
residing at 84 Franklin Street, Waterbury, Connecticut
Age 57
years. Date of order of admission January 21, 1941
Date certificate issued
January 21, 1941
by the
Common Pleas
Court at Waterbury, Connecticut
Reg. No. 1695717
Petition No. 11135
George (Complete and true Pawell signature of holder)
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