lxietct, T 32. Date of Arrest Mo Day W R- 93 ou. 33. Oase cl CrIrre Mo Der Yr e e3 os* 34. Sex Ofkodes Address at Mine Of Arrestereel No . Street Narre, Bug. Ne. Apt No. 35. City Stete. Zp 36. Cauer 37. Canecten(S) lar Regeratim Purposes («Am Sekretion. If appecable) - PaCUYIYM ge "r9SY1 .4 I fr