MODELE DE FICHE CANADIENNE

Formule I Formule II

(recto seulement) recto verso

( i k No

Ho'ght (without nhoes)

'omplexion T i

Date and Place of Coromittal.

Date aud Place of Con .

Crime...

Sentence

OTHER CONVICTIONS— ùû chronological sequenco,.

Date.

Tlacc and Court

(Su«o if ut Ass.. Sess., or Police.)

Offence.

Sentence.

Fui! Christian and >ixr:.

* sT*

Warden,

-.Prison.

Date.