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Registrant ID: Country: Registration Date (Conflict): Registration Location: Card Type: Serial Number: Registrant Name: Immigrant ID: GALL-26NOV1902-0-6-0001 Age: years Birth Date: Home Address: Birth Place: Occupation / Employer: / Citizenship Status (Country): / Height / Build: / Eye Color / Hair Color: / Nearest Relative Name: Relationship: Nearest Relative Address: Nearest Relative Immigrant ID: Comments: double rupture operated on / signed: Sam E. Caffejian