|SEX
+--------------+ | |__________
|FBI No. | | |RACE
+--------------+ |LAST NAME FIRST NAME MIDDLE NAME|
-----------------------------|----------------------------------+----------
SIGNATURE OF PERSON |CONTRIBUTOR |ALIASES |HT. |WT.
FINGERPRINTED |AND ADDRESS | |(IN.)|
| | |_____|____
| | |DATE OF
-----------------------------| | |BIRTH
RESIDENCE OF PERSON | | |__________
FINGERPRINTED | | |HAIR |EYES
| | | |
-----------------------------|---------------------------------------------
OCCUPATION |ARREST NUMBER|LEAVE THIS SPACE BLANK
| |
-----------------------------|-------------|
SCARS AND MARKS |PLACE OF |
|BIRTH | 22 M 11 U OOO
|-------------|CLASS__________________________
-----------------------------|CITIZENSHIP | L 6 U OMI 13
SIGNATURE OF OFFICIAL |DATE | _ |
TAKING FINGERPRINTS | ||_|CHECK IF |
| | NO CRIMINAL|REF.___________________________
| | RECORD IS |
| | DESIRED |
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1. RIGHT THUMB|2. RIGHT INDEX|3. RIGHT |4. RIGHT RING |5. RIGHT LITTLE
22| 11| MIDDLE 19| O| O
| | | |
[Illustration]|[Illustration]|[Illustration]|[Illustration]|[Illustration]
| | | |
---------------------------------------------------------------------------
\ | \ | \ | W | W
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1. LEFT THUMB |2. LEFT INDEX |3. LEFT M|4. LEFT RING |5. LEFT LITTLE
18| 10| MIDDLE I| I| 13
|