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Specify and to v�at d�.gree � <br /> ��.. ,Y <br /> re �•*_s • - �l ._� , � y � . <br /> °` 'r'Tere,•.you ever in the+.'U.;6. .4rmy, Navy, or %?arine Corps � t� � <br /> �� ;`', :If :,sa, give dates of enlzs-�n�r.�"•and dischar�e _ �• � <br /> � � ;.` :Z. � ='' �` �, <br /> y f :.. � � <br /> � i,� .. -��,c� you. ever S86 ACt1V0 SeT'V1C@ � <br /> ' -��Rarik`s�,attained ` `- <br /> l <br /> � `.5_�'-.ti'�.- , ra, . , ;� } :. _ , <br /> � .r ;s,� • ti_: ' <br /> ;� ,S� How many persons are dependent upon you;f`or sunport ^ ` � <br /> : � � .�. - , �: ' <br /> .. t -.� ` ���.�.. � <br /> '• Is'ydur life insured l�re you in porfect health , .•.� -�-t <br /> ;;.:= L s ...ti, i , _, <br /> _ y f : ` . :. . . . . . .I_..� . .•� . <br /> :�*� * ''� ,.'t�iat'.�irl.nesses hav�.you had in the past 10 ye�.rs <br /> ,��t� •. .•.� z. t` ,.� <br /> r; �� . _ T .y�" r? ••`�' <br /> , ,,, ". ,'- , '. t �. <br /> � 1�Jliat�physical defects have you .� ; <br /> ^� . *, _ _ �� ,,�:..•t t i : <br /> , +� . ,-. : �.� � ` <br /> '�d:zen ar.d for vThat 't � ` ' <br /> �j�FY_�!��-�iave'�you ever had an operation __ , .; _ �,, <br /> *� :, � <br /> ; <br /> � � -` i�t�o you drin!> intoxic�.ting liquors _ I�2oderately � In ex�s�- <br /> , � r� ' s >an member of our fu.�i1- in �oor health? Give narticulars � `f 3' <br /> � . � � � Y y ^ . <br /> ,� i F ,j <br /> y ,� '=s . <br /> ;��,'.r�� ���' • : :` +�� ' <br /> ' . t� 'l�`5,� ~ , + . ;t� . � <br /> p � = rt� �•�. ��it� � , <br /> �I � ``, ,y5�� ��re your ��.rents living _ 'If de�.d, g�ve age at demise and c�ii��c� of,_�"de�th _ <br /> .. ,wC°,;,1 � � , y' 7 - . <br /> �b� • <br /> . : { �. ! ,a)�` --_ ' . � , ��t� � . <br /> Y � � . M�� � .. �•� <br /> , } %" `.� . :i�.. • ' y�� . <br /> •. f.+ ,`t a� l r �..�-," .. <br /> �: m ,�o ypu �;x�ry extensive chArge rzccour�ts _ Hov�r rnuch do you owe. �,�` `���, . <br /> ;'�, �;� -�o rovhb}ii _ � _� <br /> s; ��'` , . � ::' <br /> ';,� �t` ' ' <br /> � . . <br /> J � . ..k � y"�''�,° -M.�j�'_• � ` . .. ��� � . _ _ . j y ,`, . <br /> •.9 .t_�• � � .j`t�.1�- e{y , -.. . S�' ,.Y .' t,�._+ �' c�-� �f�� <br /> `;�,�J�` , - ,.� � . �.. - "�..�'"�F%'�'� `�a., :•� ` t j,� <br /> ' �' • . . � . .. . � �� ► Y� , - -}, �)� <br /> . . . . . i� . .•1.sL'��i.�.l'.. <br /> � . <br />