Part 99, page 58

Transcript

The scan is the source; the transcript is machine-generated from it.

PRINT ALL ENTRIES "LOST DOCUMENTS" DATE:

Name in full: | Your permanent home address: James Dwight Booth | Box 1116 Cut Bank FIRST MIDDLE LAST | Montana

Date of Birth: | Place of Birth: | Your rating on last vessel on which | | you were employed: 1 DEC. 1927 Duluth, Minn. | OILER

Full name of last ship on which employed | Date and Port signed on that vessel: SS NORTH PLATTE VICTORY | DATE: 19 Jan. 57 PORT: SEATTLE

Merchant Mariner's document or | Number of other lost certificates: Certificate of Identification. | (A, B, C, D & E certificates) Number Z- 639 126 | Number

At what port were the lost documents | On what date were lost documents issued? | issued? Various | Various

Ratings shown on lost CERTIFICATES OR MERCHANT MARINER'S DOCUMENT: WIPER FW/T OILER TR ENGR

Are the documents for which duplicates are requested, or any endorsement thereon, currently revoked, suspended, or voluntarily surrendered? Yes No [ ] [ ]

"LOST DISCHARGES" (Check one) NO NOT fill in spaces below if you are NOT filing for lost discharges.

SEE REVERSE SIDE

NAME OF SHIP IN FULL ON VESSEL | DATE SIGNED ON VESSEL | DATE SIGNED OFF VESSEL | RATING ON VESSEL | PORT OF DISCHARGE

It is requested That I be furnished A complete record of my sea service from and including [guess: last] to and DB COOPER-44485 including 1953 (Approximately) 20 [guess: discharges]

SEARCHED INDEXED (VERIFIED FILE) NOV 2 9 [illegible]

(OVER) 16 H. 81- [illegible] 29