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OREGON LIQUOR CONTROL COMMISSION

PURCHASER'S PERMIT NO. 97699

Name PALMER C. HAYDEN
Street Address 127- W. 56th ST.
City New York City, NY

[[1 Column Chart]]
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DATE | AGE | SEX | WEIGHT | HEIGHT | COMPLEXION
8/22/49 | 56 | M | 6-2 | 210 | COL.
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Issued By K Jose-
[[strikethrough]] Agency [[/strikethrough]] Store No. 9

X Palmer C Hayden

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____________ PURCHASER'S SIGNATURE

1949
THIS COPY FOR PURCHASER
1949