FOR IDENTIFICATION 



My Nan,. . . . .J^:::<^r^!^:<^:£^ 



MU He^Me.as fLj.. . .^:f:i^^^rMP<^. . .^.f .f , , . 



t/lu Buaineaa Addrass. 



My Home Telephone. 



My Office Telephone 



My Home Fire Alarm Box 



My Offce Fire Alarm Box 



se^o/ aooldent or serious II 



_ , .^.9.t. 



and my Heloht ft feet Inches - 



Size of Hat Glouea 



" Shirt Collar 



" Hosiery Shoes 



