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No. 4068756 Name NTEJADLIK THERESA KULAGA residing at -1-Potter St Danielson, Killingly Conn. Age 40 years. Date of order of admission May 12, 1936 Date certificate issued May 12, 1936 by the Superior Court at Putnam, Conn. Petition No. 2005 Theres Rulaga Niejudlik of holder) (Complete and true signature

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