No. of Watch Case ft. 



No. of Works. 



No. of Bank Book 

 No. of Bicycle 



My Weight on ••••• 



Height ' 



Si*eof my Hat » • Gloves 



" Hosiery Collar 



** Cuffs Shoes.. 



Drawers. 



.Shirt 



This book belongs to 



In ease of aeeident notify 



Ther. 



1 Ther. 



Ther. 



Wo: ~ -Wed. Ai-ril 1 9 / 19 22 



■Ther. 



Wea. 



Thursday 20 



Ther. 



Wea. Friday 21 Ther. 



