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No. 4068109
Name
SMETHURST, John
residing at
430 Jackson Avenue, Stratford, Conn.
36
Age
XXX years. Date of order of admission May 6, 1936
Date certificate issued
May 6, 1936
by the
Superior
Court at
Bridgeport, Conn.
Petition No. 19538
john Smethurst
(Complete and true signature of holder)
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Context sent to Scholar
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