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This is a fairly accurate homage to this bygone historical monument seen at the top of the photo below:
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Josh, being in the military, also has this back piece:
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This tattoo consists of a pair of variations on the caduceus, surrounding the insignias of the 44th and 30th Medical Brigades - the two units he was assigned to in Iraq.
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Thanks again to Josh for sending along these pictures and if you haven't seen the Verrazano tattoo linked at the top of the post, you must go check it out.