Document dnBB9zqyy9kyJjybeZdkMbrXR

r' L 10J_. 1'-J name Griffith, Robert employer : Phi 1 ip"Carey" AGE sc: C1TY Locklar DATE OF INJJu Iv. 1961___ OUIT_______ _________ HOUR NATURE ODFF INJ. * / . .. ____ 1 . i,L F.L " CL AIM NO 0D -119913 coimcs. 'S RETURNED riled direct' --- ---- - * RATE l ~Zr |3ll KINO u 1m 1! 1 !! ______ 1.i__.__.____ . _ _ \ V I:- - s*S - y ("'iti , ! 7<y .V:*A hi t v hi * ;i ;H W --rn;-- 1 N t \\ IN ....... ,, ' "... "_" r r __ . / j, I* Clt.fiLed form direct. Co. had clt'.' examined _____________ i;~:by Dr. Ruehlniann, who stated clt. had pulmonary;; ,| < ier.physenia with early silicosis probable. Clt1 s if ivn) ivauaovMjiv |J u [physician diagnosed it as pneursonoconiosis. C SU31UVflO r .S...t..J...V....J...A.. I: n>| s\* Il r"*----It11 /tVriNVVN ' & ,,,, ' t! C z ; i ' J*-*OSl tin :> 1