Name: John Hasak

Address: 200 21st Street, Mifflin Township, Allegheny County, PA

Age: 36 -- Date of Birth: May 3, 1882

Naturalized citizen of the United States

Occupation: Mill Worker

Employer: Carnegie Steel Co., Homestead Works, Munhall, Allegheny, PA

Nearest Relative: Mrs. Susie Hasak, 200 21st Street, Mifflin, Allegheny, PA

Mail address: 250 21st Street, Homestead, PA

White, Tall, Medium build, Brown eyes, Gray hair

Sept. 12, 1918 -- (signed) John Hasak