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No. 7059763 Name IP, Wong Gim residing at 4002 Madison St., San Diego, Calif. Date of birth 11/19/12 Date of order of admission 11/21/52 Date certificate issued Nove mber 26, 1952 by the Superior Court at San Diego, Calif. Petition No. 16821 Alien Registration No. 7379586 / wong (Complete and Sim true signature of 2p holder)