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R. No. 7565979 Name TERRELL, Elli residing at RFD #2, Litchfield, Conn. Date of birth Apr. 23, 1932 Date of order of admission June 5, 1957 Date certificate issued June 5, 1957 by the Superior Court at Winsted, Connecticut Petition No. 7040 Alien Registration No. A8 434 985 Elli Terrell (Complete and true signature of holder)

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