REGULATIONS AFFECTING SEAMEN 31

#—On what date did man sign articles. ___
5-Before whom...
6—Atwhatport.. ins
7.—Date on which voyage commenced. oo remem, iran
8-—From what Port... ee
9.~—Date on which voyage ended. ooo C—O RAT
10.—At what Porte Cb m———
11—Date on which crew was paid off for voyage.coneann. a 5 SpA
12—Date on which patient was paid Off eo JE,
13.—~Was substitute signed 08 ooo i eter pet ee
14—On what date.
15.—Name of LL
16.—Remarks Se — oso ———ar a Rb A RR A AHS, 5 arm

NIC emerson
Mactor

Date. wo—
NAMES oF Ceew oz Persons Wao Know Facts
CONCERNING ILLNESS AND TREATMENT
oN Board VEcsET

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ADDRECCRE

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