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[[preprinted]]
Photograph of bearer

[[image - photograph]]

[[signature on photograph]] B.O. Davis, Jr. [[/signature]]

[[embossed Seal (over face)]]
Department of State
United States of America
[[/embossed Seal]]

[[Perforated text (on bottom of photograph}]]
Photograph attached
Department of State
Washington
[[/perforated text]]

4
[[preprinted]]