1. What is your own age? Age of voucher, not applicant, is wanted. If you so prefer, the statement that you are over 21 years of age is sufficient.
2. What is your occupation?
3. What is your business address in full?
4. What is your actual bona fide (legal) residence? City and State?
5. How long have you been such resident thereof?
6. How long have you been acquainted with the applicant?
7. Is the applicant addicted to the use of intoxicating beverages, tobacco, morphine, or opium? If so, to which?
8. Has the applicant ever been addicted to the use of intoxicating beverages, tobacco, morphine, or opium? If so, to which?
9. Is the applicant a person of good moral character, and of good repute?