MLUING
LIINE
CUI
SELECTIVE SERVICE SYSTEM
sS Form 2
(Rev. 4-20-67)
REGISTRATION CERTIFICATE
THIS IS TO CERTIFY THAT IN ACCORDANCE WITH THE SELECTIVE SERVICE LAW
(LAST NAME)
(FIRST NAME)
(MIDDLE NAME)
Larry
Stark
Richard
SELECTIVE SERVICE NO.
DATE OF B
LACE OF BIRTH)
Benton Hbr.,Mich.
150
HEIT10
1940
HAIR
CLOOWn
WEIGHT
COLOR EYES
Blйё
"BIue
.FT.
IN.
Otber ebvieas physleel eherecteris tHes
None
59
Jan.
27
DAY OF
19.
WAS DULY REGISTERED ON THE
. ..... ....
(MEMBER, EXECUTIVE SECRETARY, OR CLERK OF LOCAL BOARD)
REGSTRANT'S SIGNATURE)
