The Talking Machine Forum — For All Antique Phonographs & Recordings

The serial numbers would appear to date this to about 1928 :

Yes, the form number 5428 gives the date - 4/28, i.e., April 1928. This is true for most of the forms and supplements used in the 20s. These sheets are quite uncommon. Ron Dethlefson's second Blue Amberol book contains copies of virtually all of them from about 1915 through the end in 1929.

I have restored the document for future reference, and yes it is the exact same document as the first post.

I have now completed the front page as well.

Impressive! How was it done?

I uses Photoshop to remove the tears after moving the top half of the page in line with the bottom and had to research the titles using the cylinder number and use the remainders of the original lettering and use letters from the other titles listed that were un-harmed to rebuild the original titles.

Unfortunately I couldn't find all the correct letters for Jack Kaufman's name as you can see on the repaired front image.