33 



APPLICATION FOR RETIREMENT 



To the Pension Board of the 



American Museum of Natural History: 



I personally make this record of my service with the 

 American Museum of Natural History and tender it as a 

 basis for my being placed 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 five any 

 information concerning 

 toot service of which 

 the Pension Board 

 should he advised. 



Signature of Applicant. 



Date 



The above statement to the best of my knowledge and belief 

 is correct and I recommend that pension be allowed. 



matun of Employing Officer. 



