6.... .a..________ “Measmfilw ’ firm“ NUMBEfi 1. Nm (Print) inf.--- .Q-.bg.ji _.L g. $---A.J..b..c. 121.31 12.91.5131. -19.? (Middle) hat) I. ADDRESS (PI-Int) / j --_.____ ifiumhr-nd-L; um: orR. F. D numb: er) in. 8.1‘mrnoul 4. A0: m Ynna a. Pucn or 8mm 0. Cock-raw or _____.___..--___---__ .z‘-1_ 1312.32.15 a-1L_C-9_. Wm“ Dun or Bum: am” °" “““LV’ 3:1135986.-- ply-.2. -1111 /_--1. 2.. 1.4-.-Wcst---172611v_a_-.11. ..... i. ......... -1; khan) ( umber) (NJ (Day) I.) (sum n! country) 1. Nut: 07 Please}! Wuo Wm. ALWAYS Kxow~§— oun Annmsss 8.13 11%318111! 0: Tan mas N» .M. 12S---- 13.: r. T617319 £11-11“)-- --._--B1-o.-.IiIf.R- (ML. Mm. ill—3;) (mm) (MIIIIIIII) 9. Annnnss or T23" PERSON _-___-_-._J -. 4“ CAIC 61-9.9.-. -CQOJLI I..[_.- - limb-z I’lfl «Iggy: R. 9F. D. number) (Town) (County) (sum) 10.EIIIPLOYEE'I Nun: 12.1.9. :1. .5112.- W. M- .5 .A.6.-.§.:(I_--. “Ilkfina c.9- 11.12““ I Ennovulfi on BUSINESS A: .61.. S116... _C .6 I 9 6». a e Lycjmwam (Nun llWl‘ and wired or R. F. I). am «It-I (Town) (County) (Sun) I Arrmu THAT I HAVE VERIFIED Aaovu AuawIsns AND Tun THEY Au TRUI. REGISTRATION CARD 1). s. 5. Form 1. ...%::£g.11__- M133: (Rushmc' I tin-tun) Ono ,