1. Employee's Name: Mrs. Anna Raymond Rivait
2. blank
3. Address: Vergennes, Vermont
4. Business Name of Employer: Le Beau(?) Restaurant
5. Business Address: Vergennes, Vermont
6. Age: 52
7. Date of Birth: December 2, 1885
8. Place of Birth: Mineville, N. Y.
9. Father's Name: Frank Raymond
10. Mother's Name: Delia Patino
11. Sex: Female
12. Color: White
13. Give date you became employee: May 30, 1937
14. Have you filled out a card like this before? No.
15. Date signed: January 7, 1938
16. Employee's Signature: Mrs. Anna Rivait