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No. 5435810
Name
BOOTH, Harry
residing at
164 West Avenue, Stratford, Conn.
Age 41
years. Date of order of admission
January 15,- 1942
Date certificate issued
January 15, 1942
by the
Superior
Court at
Bridgeport, Conn.
Petition No. 26349
182940 (Complete and true signature of
holder)
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