TEAR OUT ACCESSION SHEET 
PLEASE SUBMIT TO: 
Dr. John C, Harshbarger 
Registry of Tumors in Lower Animals 
National Museum of Natural History 
Room W216-A 
Smithsonian Institution 
Washington, D.C,, 20560, USA 
DATE RECD. _ 
CONTRIBUTOR'S NO. 
RTLA NO. _ 
USNM NO. __ 
NIH HISTOPATH NO. 
COMMON NAME _ FAMILY ___ 
PHYLUM __ GENUS _ 
CLASS _ SPECIES _ 
ORDER _ 
CATEGORY: NEOPLASM _ INFLAMMATION _ INFECTION _ PARASITIC _ TOXIC 
DEVELOPMENTAL _ TRAUMATIC _ NORMAL _ OTHER _ 
CONTRIBUTOR (NAME & ADDRESS): COLLECTOR (NAME & ADDRESS): 
ITEMS SUBMITTED (QUANTITY): 
GROSS MATERIAL _ PHOTOGRAPHS _ 
SLIDES _ REPRINTS _ 
BLOCKS _ OTHER _ 
ORIGIN OF ANIMAL: MARINE _ FRESHWATER _ ESTAURINE _ TERRESTRIAL 
WHERE COLLECTED _ 
date collected _ SEX _AGE _ STAGE OF LIFE CYCLE 
HOW KILLED _ FIXATION _ 
GROSS DESCRIPTION _ 
MICROSCOPE DX 
COMMENTS (e.g., possible exposure to chemical pollutants or infectious agents, in¬ 
cidence and duration of this condition in the population, etc.) 
(Please use reverse side, if more space is needed) 
