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Registrant ID: Country: Registration Date (Conflict): Registration Location: Serial Number: Registrant Name: Immigrant ID: LKON-24MAY1902-0-1-0040 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: Peach Ave. & Clay Ave., Fowler / scar through left eyebrow