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No. 5794063 Name LaPALME HENRY JOSEPH GABORIAULT residing at 322 Three Rows, No. Grosvenordale, Conn. Age 56 years. Date of order of admission June 16, 1943 Date certificate issued June 16, 1943 by the Superior Court at Putnam, Conn. Petition No. 3497 Houry J. asofh (Complete and Saformint signature of holder) Lay Re true

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