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Registrant ID: Country: Registration Date (Conflict): Registration Location: Serial Number: Registrant Name: Immigrant ID: LBRT-04FEB1901-0-10*-0012 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: residence: Van Horn Ave. between Mountain View Ave. & Kamm Ave.