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No. 5089953
Name
CHISARIK John
residing at
217 Lindley Street, Bridgeport, Conn.
Age 51
years.
Date of order of admission Sept. 16, 1941
Date certificate issued
October 27, 1941
by the
Superior
Court at
Bridgeport, Conn.
Petition No.
23764
John Chisawik
Registration No.
(Complete and true signature of holder)
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Document identity
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