Laserfiche WebLink
'~, s <br />•,,. <br /> <br />I9dFd of SdrviCeJune 4------, 1980 <br />Pef sOn S?rved <br />Darrel Hesse ________ <br />(Please print name antl title) <br />SiOn3c~re----'--------- <br />(P P f 5 J f1 S e r v e tl) _------_--~ <br />MI"IED LDND~ RECLeMaTI~J4 UIVISI~7N <br />• (~tnoriz olr septa ive) <br />reed Ri f},~rlta<_BecLataa!_in¢_SpECialist <br />(Name and title - please print) <br />IM~ORT4NT: PLEASE REoD THE REVERSE SIDE OF THIS PAGE. <br />LO/79 ,I.R.S. 1973, 34-33-123 <br />I <br />I <br /> <br />