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Registrant ID: Country: Registration Date (Conflict): Registration Location: Card Type: Serial Number: Registrant Name: Immigrant ID: ROCH-14OCT1913-3-10-0003 Age: years Birth Date: Home Address: Birth Place: Occupation / Employer: / Citizenship Status (Country): / Height / Build: / Eye Color / Hair Color: / Nearest Relative Name: Nearest Relative Address: Nearest Relative Immigrant ID: Comments: right arm been broken and is subject to insanity known as dementia praecox, cert. from Boston State Hospital, 74 Fenwood Road, Boston, MA, date 17-Aug-1918 pronounces above named case