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Registrant ID: Country: Registration Date (Conflict): Registration Location: Serial Number: Registrant Name: Immigrant ID: 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: residence: Walters Ave. between Temperance Ave. & De Wolf Ave., Fowler, CA / 1st joint of 1st & 2nd finger & left hand gone