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IDENTIFICATION.

Name -:
Residence .

Home Phone
*
Business Address

Name of Firm ..
Office Phone
In case of accident or serious illness, not'-7

My Physician is; .:':.. /.--


His Address•;•:.-.--."" ~:~"-, -. .':rr-.i._
•-..,

His Phone -_._.,•


My hospital _ ^.
My Weight JLZ.|L-IIei2ht----ft in.
My Automobile, Make No
My Watch, Make Case No
Works No
Size of my
y A * >
Shoes Hosiery ,1__^_.Hat
Collar-..--..Cuffs Shirt .'
Undershirt Drawers
Gloyes _C\>.-t----_-Trousers, Waist
._ ...Length _-_
Return this book to rny home address
and be rewarded. Postage 4 cents.

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