LEAVE THIS SPACE BLANK| |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 | | LLL -----------------------------|-------------| LMM SCARS AND MARKS |PLACE OF | |BIRTH | 24 L I R O O O 17 |-------------|CLASS__________________________ -----------------------------|CITIZENSHIP | L I R O O O SIGNATURE OF OFFICIAL |DATE | _ | TAKING FINGERPRINTS | ||_|CHECK IF | | | NO CRIMINAL|REF.___________________________ | | RECORD IS | | | DESIRED | --------------------------------------------------------------------------- 1. RIGHT 24|2. RIGHT 13|3. RIGHT 31|4. RIGHT 21|5. RIGHT 17 THUMB | INDEX | MIDDLE | RING | LITTLE | | | | [Illustration]|[Illustration]|[Illustration]|[Illustration]|[Illustration] --------------------------------------------------------------------------- \ | R | \ | \ | \ --------------------------------------------------------------------------- 1. LEFT 18|2. LEFT 16|3. LEFT 13|4. LEFT 18|5. LEFT 20 THUMB | INDEX | MIDDLE | RING | LITTLE | | | | [Illustration]|[Illustration]|[Illustration]|[Illustration]|[Illustration] --------------------------------------------------------------------------- / | R | / | / | / ---------------------------------------------------------------------------