Page:The museum, (Jackson, Marget Talbot, 1917).djvu/282

252 {|
 * +PASS
 * NAME OF INSTITUTION|||NAME OF INSTITUTION
 * Gatekeeper's Check
 * Pass the||Pass the
 * to which this is attached|||to which this is attached
 * Signed||Signed
 * Date||Date
 * No||No
 * }
 * Signed||Signed
 * Date||Date
 * No||No
 * }
 * No||No
 * }
 * }
 * }