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No. 6969704 Name TOM, Yee Lai Her residing at 504 Third Ave., San Diego, Callf. Date of birth 12/28/13 Date of order of admission 10/5/51 Date certificate issued October 8, 195. by the Superior Court at San Diego, Calif. Petition No. 15828 Alien Registration No. 6975308 yes Sai Har Tom (Complete and true signature of holder)