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No. 4068244
Name
DEITLER, Anna
residing at
1050 Madison Avenue, Bridgeport, Conn
Age 28 years. Date of order of admission
Sept. 15, 1936
Date certificate issued
September 15, 1936
by the
Superior
Court at
Bridgeport, Conn.
Petition
No. 19628
xama Detter
(Complete and true signature of holder)
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