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No. 4454330 Name AVON, Edward Richard residing at 1358 Huntington Turnpike, Nichols Ct. Age 26 years. Date of order of admission May 4, 1938 Date certificate issued May 4, 1938 by the Superior Court at Bridgeport, Connecticut Petition No. 20898 Edward Richard Dwo (Complete and true signature of holder)

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Document identity
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