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No. 5214760 Name KOERNER, Clare residing at o/o Miss J. Paulin, Cedarpines Pk, Calif Age 54 years. of of admission June 13,1941 Date order Date certificate issued June 16th 1941 by the Superior Court at San Diego, Calif. Petition No. 7614 5315350 elara Koerner (Complete and true signature of holder)

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