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<br />^•r•;!\fURE _
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<br />"+ ~J Sho'.v to Y.hom, date, a tn!drrs of Jrlircrv.. Sip '
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<br />;~ sho'J to warms and date delicetrd........... (i5p
<br />} ] USLiVEn 011.`i TO .1D D:LESSFE and
<br />;how ;o whore, datr, and adJ ress of
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<br />n ~CNATURE
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<br />~`~ Show to wcem x~~d da\c Jclivr:ed..__. _. LiC
<br />Snot) to whom, dat', h addl rss n( :{"II'%r R~.. ,{l(
<br />L~ DELIVER O': L.`i TO \UDIi E:;SEF: and ~
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<br />REGISif:+t:1 I'O. CC.iT IFICD N0. L'ISVR\*D L 10.
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<br />INITIALS
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