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No. 6976088
Name BACKHURST, Dorothy
residing at 201 Henry St. Stamford, Conn.
Date of birth 11/24/04
Date of order of admission 3/11/52
Date certificate issued
Mar, 11, 1952
by the
Superior
Court at
Bridgeport Conn.
Petition No. 37585
Alien Registration No.
1000002
Dorothy Backhurst
(Complete and true signature of holder)
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