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HARVARD UNIT
EYE EXAMINATION
YES
only for driving
Do you wear glasses?
t the movies
NO
If glasses are worn, give date of last
examination now 2. 1940
(Requirement within the last 4 months.)
YES
Have you two parts of glasses?
NO
(2 pairs required)
Signature
Date 2.12
41
of
havenia Fulton
Applicant
6
63476
6
5
2
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Context sent to Scholar
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