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[[preprinted]]
IDENTIFICATION
Name... ^[[PALMER HAYDEN]]
Address... ^[[NEW YORK N.Y.]]
[[dotted line]]
Tel. No.
In Case of Accident or Serious Illness, Please Notify by Telegraph or Telephone.... ^[[W.P.A.]]
^[[Project No 565-3-1]]
PERSONAL
Soc.Sec.No. ^[[124-12-6733]]
Size of Hat ^[[7 1/2 Collar 16 1/4]]
Size of Shirt ^[[16]] Sleeve Length ^[[35]]
Size of Gloves ^[[10]] Shoes ^[[13]]
Make of Watch ^[[Lip { ]] No. of Case
                  ^[[ { ]] No. of Works
My Height is ^[[6]] ft ^[[2 1/2]] in
My Average Weight is ^[[200 lbs,]]

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AUTOMOBILE DESCRIPTION
Make................................
Body Type...........................
Engine No........ Serial No.........
Title No.......... Weight...........
H.P............... Year.............
License No........ State............
My Driver's License No..............
Name of Insurance Co or Agency......
Individual Markings.................
Special Equipment...................
[[/preprinted]]
 
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