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No. 6823662
Name COSTAS, Dorothy
residing at 29 Seaview Ave, East Norwalk, Conn.
Date of birth 11/16/15
Date of order of admission 1/15/52
Date certificate issued
Jan. 15. 1952
by the
Superior
Court at
Bridgeport, Conn.
Petition No. 37364
Alien Registration No. 1706659
Dorothy Costas
(Complete and true signature of holder)
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Document identity
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