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No. 7129180 Name DIANA, Florence Doreen residing at Mountain Spring Road, Tolland, Conn. Date of birth 5/4/27 Date of order of admission 5/21/54 Date certificate issued May 21, 1954 by the Superior Court at Rockville, Conn. Petition No. 1892 Alien Registration No. 6514414 W 218259 Honence Dareen Diana (Complete and true signature of holder)