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Unattached and Transients Div. 

5

TERA Form 225.
      
59 Leonard St.

IDENTIFICATION
No. 2516

HAYDEN PALIMER
Last Name First Name

123 W 3rd
Street Address   City, Town   Village or Borough

PERSONAL DATA

Age 41  
Height 6 FT. 3 IN. 
WEIGHT 198 LBS.
COLOR HAIR Black  
COLOR EYES Brown
SEX– MALE □ FEMALE □  
RACE Negro
OTHER MEANS OF IDENTIFICATION ____________-

Palmer Hayden   
Signature   

Thomas MacDaniel Jr
Witness