FOR IDENTIFICATION. 



My Name- 

 My ReMence- 



...Q .wLnl . !?^*a<SJb 



My Business Address 



My Home Telephone- 



My Office Telephone rrrr".'. '. , ." : rrr 



Mtj Home Fire Alarm Box 



My Office Fire Alarm Box 7. r ~ .... 



fa case of accident^or ^jj^^^ notify ■ ■ ■ 



The make of my Automobile .-n '. . .7? 



Number on case of my Watch 

 Number of the works 





My Weight was 







Height, 



■feet 



Indies 



Size of Hat 







" Hoaip.ru 





















