FOR IDBNTIPIC^ION. 



Mu Name.. 



Mu Residence. ■ m^riA^^^r:^^ ■ ■ ■ ■ ■ 



My Business Address. 



Mu Home Telephone 



Mu Office Telephone 



Mu Home Fire Alarm Box 

 Mu OSice Fire Alarm Box 



::l^.:cm}: 



In case of accident or serious Illness fttase notify 







^ mB^....9..t. 



The make of mu Aut 



Its Number. 



Number on case of mu Watch 

 Number of the works 

 Number of my Bank Book 

 Number of my Ins. Policy' 



...i.kf.^..<j.$.r. 











feet 











