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No. 7068851 Name CHAN, Anna residing at 1832 - 4th Ave., San Diego, Calif. Date of birth 10/26/12 Date of order of admission 11/20/53 Date certificate issued November 24, 1953 by the Superior Court at San Diego,California Petition No. 18173 Alien Registration No. 2790261 anna Chan (Complete and true signature of holder)