Birth Certificate
Name:
Gender:
Weight:
Height:
Date of Birth:
Place of Birth:
Mother’s Name:
Father’s Name:
Doctor’s Signature:
DOG TAG
Surname
First Name, Initial.
Social Security Number
Blood Type
Dorothy Dloc’s Fallout Shelter Packing List
Food Supplies
Medical Supplies
House Wares
Technological Supplies
Registration Card
Serial Number___________First ____________Middle Initial_____ Last_____________
Place of Residence________________________________________________________
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Telephone_______________DOB ______________ Place of Birth__________________
Name and Address of Person Who Will Always Know Your Address _______________
________________________________________________________________________
________________________________________________________________________
Employers Name and Address:______________________________________________
________________________________________________________________________
________________________________________________________________________
I affirm that I have verified above answers and that are true.
________________________
Signature
Charlie Dloc’s SPY log
Today, I snuck into East Berlin and met
my contact comrade Boris Tribeca. He
told me
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