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| Scott Number | 1 |
|---|---|
| Date | May 21, 18xx |
| From City | Cleveland |
| From State | OH |
| To City | Navarre |
| To State | OH |
| Addressee | West & Burger |
| Cert Author | |
| Cert # | |
| Fake | |
| Quantity 1 | 1 |
| Quantity 2 | 0 |
| Bisect | |
| Others |
