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Bitmap Image  |  1996-09-16  |  123KB  |  640x191  |  8-bit (17 colors)
Labels: box | bulletin board | grandstand | reckoner | right triangle | road | shelf | sky | stairs
OCR: PERSONAL INFORMATION DATE NAME: LAST FIKST MIDXU PRESENT ADDRESS STRENT cm STATE PERMANENT ADDRESS: STHEET CITY STATE PHONE NUMBER SOCIAL SECURITY NUMBER PIKST MIDU NDDRNS STRSET STAT