English Translation

MEDICAL CLEARANCE CERTIFICATE C D 1. 2 3 37 33 Temporary 1. 1st 2nd D.D.T. AL E3 M. K. HEAT. OTHER identity (25) Dates of Disinfestation Types certificate issue: (26) PHYSICAl CONditION on (27) ImmunoIzatiOn Record Number ARBIval Date DdA Signature of Authority Doso Date Injials 'I M. C. D. D D. T 1. DhS'9 (Epid) 2. HZ SSSECN 3. 67 REmarks D. 1. No. 71F074 2. 95.8.91 T. T. V Dat2 22 Feb 48 1. (Tab.) 2. 7 Calphd.Mudliid 3. 0 VOORA Is Lt. S Date FA Initials r Vacc. X47 VAA Read. Arrival Medical Ce Inspection —: Date M. R. Medical Examiner Medieval Examiner COIO 0) (30) RECepTiON CenTeR OR VISA RECORd STFAER 39237. o 2 1st DEC. 1954 NO 10-80781-1 U. S. GOVERNMENT PRINTING OFFICE