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Age __~(L years.Date of order of adrnission ~~_!.__:I.:~~__~9?_4
Date certificate issued OI ~A 1,2.~~y __~J~J __~9_5tt by the
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Petition No.L9l.h6 _
Alien Registration NO:~~~~_&:,..,....-"_
(Complete and true signature of hOl~-7~