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No. 7029407 Name GOUGH, Dan Francis residing at Box 640 B, Poway, Calif. Date of birth 4/18/98 Date of order of admission 5/16/52 Date certificate issued May.19,1952 by the Superior Court at San Diego, Calif. Petition No. 16572 Alien Registration No. 6549259 Lan Frencin Payro (Complete and true signature of holder)