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PERSONAL

NAME...

RESIDENCE...

RES. PHONE...

BUS. PHONE...

EMERGENCY, NOTIFY...

MY PHYSICIAN, HIS ADDRESS
AND PHONE NUMBER...

MY WEIGHT... HEIGHT...

AUTO NO. AND MAKE...

WATCH NO. AND MAKE...

SIZE OF SHOES... HOSIERY... HAT...

GLOVES...COLLAR... CUFFS... SHIRT...

UNION SUIT...COAT...TROUSERS...

BANK BOOK NO...

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