August 28, 1967
Shri Radha Damodar Temple, Sebakunja, Vrindaban
Shri Radha Krishna Temple, 2439, Chhipi Wada Kalan, Post Box No. 1846, DELHI-6.
Be it Hereby known that Kīrtanānanda Brahmachari (Keith Gordon Ham) was initiated by me into the Sannyas Order, Goudiya Sampradaya, as TRIDANDI SWAMI KIRTANANANDA, on this 28th day of August, 1967, at Vrindaban, India.
His Holiness A.C. Bhaktivedanta Swami
Witnessed and assisted by:
His Holiness B.S. Yachak
[ATTN: illegible hand writing here]