FOR WENTIFI CA TION. 



FOR 



My Name - ...... 



My Residency / - - (jfff&ttiXn .^K fcl - - 



Mu Business Address 



My Home Telephone 

 Mu Office Telephone 

 Mu Home Fire Alarm Box 

 Mu 00 ce Fire Alarm Box 



i case of accident or sejypus Illness please notify 



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Its Number 



Number on case of mu Watch 



Number of the works 



Number of mu Bank Book 



Number of mu Ins. Pollcu 



Nameoflns.Co 



Mu Weight was-. , On 



and my Height feet Inches 



Size of Hat ..Gloves 



" Shirt Collar 



" Hosleru Shoes 



