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No. 6801967 1 MANGE, Sam Name residing at 4747 - 70th Sts, La Mesa Calif. Date of birth 3/26/98 Date of order of admission 7/29/49 Date certificate issued August 1, 1949 by the Superi or Court at San Diego, Calic. Petition No. 12971 Alien Registration No. Sam mange (Complete and true signature of holder)