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					Name | 
					Yamamoto Hirohisa | 
					Date of Birth: 1966-2-14 | |||||||||||||||||||
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					Adress | 
					 2-11-1 Tianshen, Ikeda City, Osaka | ||||||||||||||||||||
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					Latest replacement date | 
					2014-2-4          11840 | 
					driver's license | 
					Photo | ||||||||||||||||||
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					Valid Period:2019-3-14 | |||||||||||||||||||||
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					Driving conditions(good): glassess, midsize cars, midsize cars only (8 Tons) | |||||||||||||||||||||
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					No. | 
					638500810950 | ||||||||||||||||||||
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					Wheelers, car, original vehicle | 
					1985-2-20 | 
 | 
					Osaka Public Security Commission (seal) | ||||||||||||||||||
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					Others | 
					1985-9-24 | ||||||||||||||||||||
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					2nd class | 
					1989-0-0 | ||||||||||||||||||||
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					Remarks-------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------- | 
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					Statement on the provision of internal organs of the human body (voluntary) If yes, draw a circle in the 1-3 option 1. I hereby donate internal organs after brain death and cardiac arrest 2. I hereby donate internal organs only after my heart stopped 3. I do not donate internal organs 〈Put a fork in the following that you do not want to donate after you choose 1 or 2 above〉 (heart, lungs, liver, kidney, pancreas, small intestine, eyeball ) 【special record】(signature) (Date) |