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No. 4108573
Name
LOSS, Bella
residing at R.F.D. #1, Stepney, Connecticut
Age 46 years. Date of order of admission
May 4, 1937
Date certificate issued
May 4, 1937
by the
Superior
Court at
Bridgeport, Conn.
Petition No.
20123
x Bellre Loss
(Complete and true signature of holder)
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