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No. 5773379 Name NIELEN Leo Gunnar residing at 1530 S. 39th St. San Diego, Cali 1. Age 40 years. Date of order of admission November 13, 1942 Date certificate issued No vemb er 30, 1942 by the Superior Court at San Diego, Calif, Petition No. 9176 LEG930 Il (Completorand gunmar true signature of holder) nielen