Name: Peter Fulaytar

Residence: R.F.D. #1, Wheatfield, Jasper, Indiana

Mailing address: Same

Age and date of birth: 64, March 3, 1876

Place of birth: Doboroska, Hungary (Doboruska)

Name and address of person who will alway know your address:
Susie Fulayter, R.F.D. #1, Wheatfield, Indiana

Employer: Self - farming

White, 5 foot 7 inches, 155 pounds, brown eyes, gray hair, ruddy complexion, Blind in left eye

April 27, 1942 (signed) Peter Fulajtar