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No. 6069908
Name LEISS, MARY DOMENICA
residing at
29 Ivan Hill, Willimantic, Conn.
Age 40 years. Date of order of admission
Mar. 21,1944
Date certificate issued
Mar. 21, 1944
by the
Superior
Court at
Windham, Conn.
Petition No.
3372
mary (Complete Domenica and signature of holder) Leiss
true
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Document identity
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