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1 No. 6784903 Name JIMENEZ, Pe tra residing at 2171 La Jolla Ave. San Diego, Calif Date of birth 2/18/16 Date of order of admission 7/23/48 Date certificate issued July 23rd,1948 by the Superi or Court at San Diego, California Petition No. 13611 Alien Registration No. 5047012 Petre (Complete and true signatage Jaminay of holder)