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3 No. 6969486 Name PARK, Mike residing at 1354 India St., Sen Diego, Calif. Date of birth 3/5/90 Date of order of admission 8/17/51 Date certificate issued August 20th, 1951 by the Super ior Court at San Diego, California Petition No. 15678 Alien Registration No. 5894557 mm pach (Complete and true signature of holder)