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 
COMMON NAME ___ FAMILY _ 
PHYLUM __ GENUS 
CLASS _ SPECIES ____ 
ORDER _ 
CATEGORY: NEOPLASM __ INFLAMMATION _ INFECTION __ PAPASITIC _ TOXIC 
DEVELOPMENTAL _ TRAUMATIC _ NORMAL __ OTHER __ 
CONTRIBUTOR (NAME & ADDRESS): COLLECTOR (NAME & ADDRESS): 
DATE RECD. _ 
CONTRIBUTOR'S NO, 
RTLA NO. _ 
USNM NO, ___ 
NIH HISTOPATH NO. 
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 CYGLE 
HOW KILLED _ FIXATION _ 
GROSS DESCRIPTION _ 
MICROSCOPE DX 
COMMENTS (e.go, 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) 
