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No. 4854602
Name MAGNAN, Camille Adelard
residing at 330 Church St., Putnam, Conn.
Age 36 years. Date of order of admission
May 14, 1940
Date certificate issued
May 14, 1940
by the
Superior
Court at
Putnam, Conn @
,
Petition No.
2713
samille
(Complete and true signature of holder)
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