SERIAL NDMDER I I. Nun: (PriIIl) 7 ORDER NUMBET: / (203$ ______ [WEE suds. \flCD eke. ......... -muncl ........ I. "1232-?“- (Firez) (Middle) 2. ADDRESS (Pti . . _- ......... 10:" ..... 0‘1 ms».-- .51 fit.-- .Bno‘ e. AISLE-husfslnfia; ..... E- .8.--- .‘(Number Ind erect or R. F. . numbar) (Town) (County) (State) 3. TELEPHONE 4. AGE IN YEARS 5. PLACE OP BIRTH 6- C%UNTBY OP -. -I1‘IZENSHIP --?-9:q§:.\§s.¥aw— ................ E 5 ...-E‘o.u X); - -319.--" DATE OP Bun-H w“ °" 5°“ ._.....5. 1...»; -...5 ..... mm; ..... ...-§.-.XA .lX..- (Exchnnzr) ( (Mo. (Du-v) (Yr.) 7. NAME 01" PERSON WHO WILL ALWAYS KNOW YOUR ADDRESS 8. RELATIONSHIP or Tun PERSON .............. [’1 ..I-......-.....O Ago-r-....uH“ em WEI—RAW... n- man-(X Efixgr.-........ (ML. MIL. Miss) (First) $(Middle) (Luz) 9. ADDRESS or THAT PERSON ......... -11.-)141: I'IIWAv-b 9.9-- $533 55.19:. (Number and Stree 01' R. F. D. numbar) (Co 10. EMPLOYER'S NAME .............. X). n.e.v.v.\. L2. {2‘ ll. PLACE OF EMPLOYMENT o BUSINE 5 (Number Ind Street or R. F. D. number) I AFFIRM THAT I HAVE VERIFIED ABOVE ANSWERS AWTHA’P- REGISTRATION CARD D. S. 5. Form 1 10—17105 (ovar)