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 CYCLE 
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) 
