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/~ H; ..... ....M. 0.... .. / M ....Dcpot Battalion... .%

PARTICULARS OF REC

DRAFTED UNDER MILITARY SERVICE (Class ........ M1 .............. u...)

l. Surname ............ . ............................................................................... 2. Christian name. .. .. ..

3. Present address .................

4. Military Service Act letter and number... 3” Jifé/Z

(If man in defaultmr, 122.. has not reliatflcd under Proclamation this (act aha-11d be stated town:

5. Date of birth ........... .. .. /6,1. 48;; ............. . ................

6. Place of birth. WW _/ £7 e/

(tow-r1. township or county and country]

. 7. Married widower or single... . gm .4, ....................... 8. Religion ........................ /25M é' ............................................. 9 Trade or calling ............. VZ .. . ._ .

10. Name of next—of—kin ................................. 7% ............. . ......................

11 Relationship of next of— kin

w

12. Addrws of next-0f»kin,.. ........................................................ / ..... do

13. 'Wllethcrat present a member of the Active Militia. M

14 Particulars of previous military or naval service, if any ......... 777/”- . .

15. Medical Examination under Military Service Act. —

........................................ (b) Da.1e:7”,7w/VG9

(a) Place..

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