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Vol XLIX P9105
No. 4723199
Name TERNI, Ottavio Decl XXVII Pg 435
residing at 65 Elizabeth St., Waterbury, Conn.
Age 31
years. Date of order of admission January 15, 1940
Date certificate issued January 15, 1940
by the
Common Pleas
Court at Waterbury, Connecticut
Petition No. 9955
Ottavio Terms
(Complete and true signature of holder)
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