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Name: Clara Sara Cohen
Date and place of birth: 26 February 1894, Gorredijk (gem Opsterland)
Original address: Winterdijkstraat 36 II, Amsterdam
Identity card: vals
Ground for hiding out: jodenvervolging
Hiding address: Douwe Wagenaar, Nieuweweg, Siegerswoude
District of the LO: Drachten