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Form | RUCTIONS;: Please.PRINT below your name as it now appears on University records. State your request and Rive your reasons in i baln written approvals as directed by. Registrar: Z lobh.£.... . od inte plo . Scott... so Firyt name Middle names Family name - Number (See Régistration Card):. Met t.. htpe ah. ad ¢ Registrar: for reasons stated below, I make the following request: yt VAM EG ow all duiveatity fecondy hott . Tack Seott hathea Chan She Vweent Seo Reasons: My Finat Mae los been Lath haasel Frans Sohn Vearerat Zo. Tack, | ' ele DIL st C. % Leth Ore / er~ THE Ath dele (66 i Sea j /L (A tS /ier- Cr i Rove dalivv HO ue c“o SS <a SS IE ce W) ee / Gir * 7) : —_ ~ Ntiddf names. oe Family name Mrs, ; Present P.O. address:.- SEO... ir aes t.. va Oak hid. ae ie oka. SY... _ State and ZIP code “Number and street - City % i Graduate or Coliege or _ . Major on %: Undergraduate’... secanseenteeeeenees EA det Subject. Mola" Eset Fo 1 was last registered for the ion nvecommende onto war PO to ACTION, NOTIFICATION, RECORD Data Processing section notified... is SS .- 242K, XD cecuecuamaunsenesuuerccnsgesnessosesuscengranenaregenoessaadppenaegqnrsnanaperes reese ceneeem ; ; Mo. Day Yr. Peogty sasesestncneacoseceapensensesrecnenereysonmin Student notified............i.... | GAL. Ze NH . Mo. Day : nips oy us, 7, LD. 4 eraeeemee re * an Te Ye oN