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MacBinary  |  1987-02-26  |  7.0 KB  |  [AWWP/PSIP]

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This file was processed as: MacBinary (archive/macBinary).

You can browse this item here: Death w⁄ Dignity Declaration

ConfidenceProgramDetectionMatch TypeSupport
10% dexvert MacBinary (archive/macBinary) fallback Supported
100% file MacBinary II, inited, Thu Feb 26 10:37:40 1987, modified Thu Feb 26 10:37:40 1987, creator 'PSIP', type AppleWorks word processor, 6473 bytes "Death w/ Dignity Declaration" , at 0x19c9 443 bytes resource default (weak)
99% file data default
49% TrID Mac AppleWorks word processor document (MacBinary) default
33% TrID SpeedScript document (C64) default (weak)
16% TrID MacBinary 2 default (weak)
100% siegfried fmt/1762 MacBinary (II) default
100% lsar MacBinary default


id metadata
keyvalue
macFileType[AWWP]
macFileCreator[PSIP]



hex view
+--------+-------------------------+-------------------------+--------+--------+
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