Document r690L7XOEby3BYJED92KRnYG0

_L name Griffith, Robert employer: Phi 1 ip Carey- 1.Li_!_L!lJ_'Ll. \_Ll_..LL. F1f | M CITY Locklar CLAIM NO COURES DATE OF tNJ.Jujy 1961 QUIT_________ HOUR RETURNED NATURREE OF INJ. * , ( l * , . / . - OD-119913 P. P. DIS DATE /<&'-. 1684 MANUAL C.I / C FORM ____ DATE RITC'D Tiled direct >I N _ EST. ___________ _ S, S NO. _______________ MEDICAL. _ COMPENSATION DR. OR HOSPITAL ____________________________________________ ___DATE _ PERtOD_________. AMOUNT ?! Xj -/- C-rO _____ ;_JL____ " " <hV- E y- xa . r.A ^ .stt X -,y /i_il4l ' <: LgL. .^..y /-? i?..Z____ 7_____I___7___________ L /!. T -i'' - X27- ... / !- RATE S'S - v C'X (i 7" (X~>" Xj,.. / ,n j* Clt.`filed form direct. Co. had clt'. ` examined]! ________________________ __i; - ;by Dr. Ruehlmahn, who stated clt. had pulmonary]!'* ;j < [er:ij>hyseiTia_with early silicosis probable. Clt`s L[ IVN) nVOIJLBUVHdnv sxinh zt j! u iphysician diagnosed it as pncumonoconiosis. .. 1A\. stoxuyno "S 1VONVW I lift! I: <"l> *"*i! C z I i I. v ! Z I 1 1'7<i i t! A'"VlTt J1 ?* ).I