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IF FOREIGN BORN. D* NATURALIZATIO.. PLACE OF BIRTH : STATE OR CovntRry County City on Town MONTH | t Mey | 7 - - 1 o> - ~ = } Applicant’s ; 5 | ; a rr} Husband or Wife_.}......... Ley. a ee ok jae (you r 17 rT - a ' 1 on Gara d Applicant’s Father.|.......--.. (os fee! bees cevececceececsscee. ho ieee fe “Oe, po. | \ , “ pow . | , [ _ - f A _ Applicant’s Mother 0... LE d rad | are | ole d ead 11 brn _— / / 35. Ip, ry Your Oprstox, You Have Hap Specian TRAINING OR Experience Wuoicn Qcauiricrs Kou ror THE Panticrian ug Wisse ro Do, Make a DETAILED STATEMENT IN SPACE Betow, Nempeging Eacu Statewent to Corresraxo With tae EF: Recorp UNDER QUESTION No. 31. 4 r a ~f, re 4 ‘ ‘ ~ . _ ~ f ya) - i ; as te ee Yn Sea SVE ince YS Kd a“ “¥ Oo fT ’ ~ ‘ ee Piz. o_. oak Eee Ba PVA bel GE oc jon: J - 1 TL yo we { ‘ ¢ to _ . vy. - vA 4 tf nn, es Md Aa, Lb wi fet ee vi 7 = eo —7 36. Ix Case or Exencency, Noriry— ~ a at Name . L | Street address A _—— rele Fylt ert JL 4 Ts cot ls# LFS ! Relationship ‘ Telephone | City and State va , ' a “ ’ . - wes -x2%42— . if rare) COL KL’ V : : I Centiry that (He forecoing staternents are true and complete to the best of my knowledge and belief, (Any false statement is s : cause for rejection of the application or dismiss! after appointment.) . : (The Office for Emergency Management reserves the right to investicate all statements mace in this application, Copies ‘ lications or other datz may be submitted with this application to support your cendiducy.) fj: - ji : ra “ é a ‘ ! U. &. GOVERNMENT PRINTING OPTICE WH Qhas (Signature) / u C L f LL . ye - i SHIGA (Sten ene piven mtoe id Be iitisl or mately, iCyou hase ais, a9 Pyeqpe 3