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Two leaves, typewritten on the front sides. The document is in good physical condition. The document was laminated. There are three significant lamination-related creases on the first leaf. The upper left corner and the lower right corner of the first leaf were folded into the laminate. The upper left corner and the lower right corner of the second leaf were folded into the leaf. There are staple holes at the upper left corner of each leaf. There is some minor fraying at the lower right edge of the second leaf. There is a minor tear at the left upper edge of the second leaf. There is a minor tear at the lower right edge of the second leaf. There are minor stains of unknown origin on the document. There is some acid-related staining at the left edge of the first leaf. The document was folded horizontally in half. There are textual corrections handwritten in both pencil and blue ink.

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