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No. 8573449 Name MARCHESSEAULT, Ingrid Mary residing at 94 Daggett Street, Moosup, Connecticut Date of birth Nov. 27, 1942 Date of order of admission April 28. 1966 Date certificate issued April 28, 1966 by the Superior Court at Putnam, Connecticut Petition No. 5483 Alien Registration No. A12 180 023 Ongrid (COMPLETE Many AND TRUE Mardesseault SIGNATURE OF HOLDER)

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