--------------------------------------------------------------- MILITARY SERV.:___________________                              EDUCATION:     ___________________                                             ___________________                            
 POLICE REC.:   ___________________                              BANK:          ___________________                                             ___________________                              LOANS:         ___________________                            
 AUTO REG#:     ___________________                              DRIVING REC.:  ___________________                                             ___________________                              FRAT. ORGAN.:  ___________________                            
                ___________________                              RELIGION:      ___________________                              CIF 10
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 DCA I (2640)
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NAMED, DEVICE DTA0
NAME, FILENAME PATBUF.SV
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20410  7300   CLA CLL
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204 ***********CRUDS8 ************VERSION 4/12/74*******PAGE*1***** NAME:          _____________________                            SSN:           _____________________                            ADDRESS:       _____________________                       
                   _____________________                            TELE #:        _____________________                            INSURANCE CO.  _____________________                            EMPLOYER:      _____________________                       
    PAY RATE:      _____________________                            RETIREMENT PLAN_____________________                            SUPERVISOR:    _____________________                            JOB DESCRIPTION_____________________                       
                   _____________________                            SECURITY CLASS:_____________________                            VACATION PLAN: _____________________                            CREDIT REF.:   _____________________                       
                   _____________________                            SERVICE REF:   _____________________                                           _____________________                                           _____________________                       
    **********CRUDS8 ************VE SION 4/12/74*****PAGE*2******** MARITALS STAT.:___________________                              CHILDREN:      ___________________ SPOUSE:     ________________                ___________________             ____________
___

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