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' JL)('{ 23 '94 05=57PP1 DIV/MINERgLS&GEOLOGY <br />Cemolete it.ms t and 2 wMn addit;on•I services are desired. end' cor <br />se to th• "RETURN YD" 9p•va on tna nwne aide. Fsilyre to de thlc wilt <br />lp returned to yov. Lu reevLnc.7Ilt f• wIU nrovlda rou tM n•m• of the wn <br />of all er or sddinona roes • o owing mrncu ae eva • •, tru <br />m o for eddl4onet emicepl ngwrted. <br />to whom dolbered, dpe. and addms••'s oddresa. 7. O Restricted De <br />3, rticM Atldffrs;aetl lo: <br />.~Gtrf~ <br />C~F'J/Hl4++t ~ <br />C <br />1 <br />S <br />~.r~Q <br />~I 4. Anlcle ^N~umber <br />oC 1 ~'~ <br />, <br />t <br />4 <br />lsC <br />U(. f <br />-- <br />[ ~'~ of 8ervite: <br />/' <br />V. ~~ n <br />CCl <br />F'G L~~I R~~gbreed Q Inured <br />p <br />' <br />nn ///LL <br />~'71~(}vcK <br />`CX!) <br />r `- ~~// <br />/7r•L ~' ~1 c~.,~J ` C•.Jf Y1 cens+;.d <br />!!! <br />coo <br />[] Eaor•s. M•:+ [] Rer m Mcol t <br />or s se <br />~ <br />((~J <br />~ /~/ ~ / <br />QE r ~7 /NCq ,y ,[, <br />!3J Y.W+- Atwen oot,;n npn•lure of eddrou•e <br />or apml end DATF DEIIyCREO, <br />6. 9ignatyn - Atltlreae Addrsesu's 40dress (OrrLY iJ <br />x nqueard and Jae pond) <br />6. 9i naturo Ay nt <br />r _ <br />Form 36 1, Mar, 1970 • uS.O.P,o. 188e-212-ee5 DOMESTIC RET(1RN PtCEI.7 <br />F.2/11 <br />2~ <br />RECENT <br />