Partly printed DS, one page both sides, 7.75 x 3.25, January 15, 1965. A federal W-4 employee withholding exemption form, filled out by Karloff and signed twice (once with printed block letters). Matted and framed with a photo to an overall size of 15.5 x 22.25. In fine condition, with staple holes and mild handling wear. PSA/DNA Auction LOA and R&R COA.
