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BUREAU OF CONSULAR AFFAIRS CERTIFICATE OF LOSS OF ...
Embassy/Consulate of the United States of America at ss: I, . Name hereby certify that, to the best of my knowledge and belief, Name was born at Town or City, Province or County State or Country, on Date That: he/she resided/never resided* in the United States ; That: he/she resides at ; That: he/she acquired the nationality of the United ...
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