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~ III IIIIIIIIIIiII III ~ <br />N <br />e' <br />P <br />4 <br />s <br />+cr~~nc.- ('py~.ltem~ 1..7. nA J. <br />Add you addaen !n tAe'•RETURA 70' y.o m <br />main <br />1. '(td eaBevlas terrln Is oegaested (crecR om.) <br />~"_Cf',~', toa~Lom and dam dcllvusd............ _t <br />r <br />^ St/ar foa8tan, date and addrcts of ddivegc..-4 <br />~. RE4IAR'IED QELIV F32Y <br />56o.f to vIIam a.d date delivered............. • <br />^ RFSTRICCLD DEINERY, <br />$ov to ahan, dart, and eddrea of dellveq.S- <br />(CULT PQSCWAS!'CR FOR FLL•S), <br />;. ' AilidlAOORFlCTDTO~ <br />M~a MLS Qy/-,Qc~r F.i-lo~o~c <br /> <br /> <br /> <br />i AgTif18 DElaiW71ON: <br />RiO1is[II[L W. CIGtIF[F.~HaI 4t41Rm N4 ' <br /> <br />JOZr <br />(A:.wTS tstrtafn aipuwta of addta~ar oe agsm) <br />I Aava received thcatfcfe ducdbed abrn~a <br />f:7G>AAAIfNF ~A.ibalrAd aamf <br />t <br />DAT>i w al:uvc~v ^ <br /> . 9,,; <br />6 4 [C~Yw N Y -~ .^ ~ ~~j <br />C 1 , <br />~ <br /> ~ <br />_ <br />~ <br />~ <br /> •~ <br />.. WAili TO DlWFJI GECAlEF: n~ ( CC€ ". <br /> <br />N~ : t!f]pJOp{50 <br />~~cFi <br />~iy~d 9pR ~C <br />O <br />G~4 ~at~~FO I f9g9 <br />fy~fG~d ~~ ~~ /~`of <br />~l <br />~i <br />/,~ / <br />