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No. 4068427
Name KLEK, Bronislawa
residing at
24 Sherman Street, Bridgeport, Conn
Age
33
years.
Date of order of admission Feb. 2, 1937
Date certificate issued
February 2, 1937
by the
Superior
Court at
Bridgeport, Conn.
Petition No. 19846
Bromistana Keek
(Complete and true signature of holder)
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