Page 6 - hb1906_docs

REGISTRAR'S REPORT
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DESCRIPTION OF REGISTRANT ~ k~ ~ L " ;
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R.A.OE HErGHT WEIGHT 1ll'"3 !:" ~ "' 11:1 I ~"" i,: l'J !Jt:o,... l;d I ""
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Other obvious physical cbaracterlstlcs that will aid in idcntillcu.Lion _____________ _ ! 0 q ~~~ : ' j\J b
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I certi1y that my answers are true; that tho person registered bns re~d or has hod ... ,. :~ ~ : -1
read to him his own answers; -tbat I have witne.'lSed his signature or mark and that I I ~: I ~ ► I : .......... .,
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&ll of his answers of which I have knowledge are true, except as !ollows: '( _, ~ @!- - ;::i:~ i,s ;:ii--..:;, 'l"h
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Beglstrarfor _i---~~,.r- __ ~----~---- 1 I l I I t I -• - I N'
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b (Ward) (City or oountv) (8to.te) I I 0 !"-._ ~ i
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Date of registration , -: __ .l.5!_.51!:(2_ ___________________ _ "I oo i a i•• it)
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loe~I Board No. 175 ! I :," ~~ : I I I I ~
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rra Hbthway 1175 ~ -, : ~
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(The atamp of ~ho Local Board hav~ jurladiolio11 of tho regietrant
ehcJl bo plaood in the 1Lbovo epooo.)
11, 3, GOVUN IUNT PRINTING Cl'f'IC& 16-17106