APPLICATION FOR RETIREMENT 



American Museum of Natural History: 



I personally make this record of my service irith the American 

 Museum of Natural History and tender it as a basis for my being 

 I on the Pension Rolls of the said Museum: 



Name in full 



Address 



Date and Place of Birth 



Reasons for Retirement 



Length of Service 

 Remarks : 



In this space give any 

 information concerning 

 your service of which 

 the Pension Board 

 should be advised. 



Signature of AppllC int. 



Date 



The al menl t<> the best "f my knowledge and beli- 



correct and I recommend that pen-ion he allow* 



'i a tut e if Employing < > 



