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Transcription
IDENTIFICATION
Name. HOBART M. VAN ILEUSEN
Residence. 13 STONEWOOD PKWY.
City. MONTCLAIR, N.J.
Phone. P1 4-5409
Bus. Add....................
City........................
Phone......................
Blood Type..................
In case of accident or illness, notify:
Name.......................
Street.....................
City.......................
Phone......................
Insurance Agent............
Phone......................
Car License No.............
Driver's License No........
Social Security No.........