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No. 7597567 Name LIEPINS, Karlis residing at 87 1/2 Lewiston Ave Willimantic, Conn. Date of birth Oct 20, 1916 Date of order of admission June 13, 1956 Date certificate issued June 13, 1956, by the Superior Court at Putnam, Connecticut Petition No. 4860 Alien Registration No. A7 474 571 Karlis helpins (Complete and true signature of holder)

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Document identity
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