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| Scott Number | 1 |
|---|---|
| Date | January 18, 18xx |
| From City | Boston |
| From State | MA |
| To City | Randolph |
| To State | VT |
| Addressee | |
| Cert Author | |
| Cert # | |
| Fake | |
| Quantity 1 | 1 |
| Quantity 2 | 0 |
| Bisect | |
| Others |
