REP36939

• Permit No: M1974015
• IBM Index Class Name: Report
• Doc Date: 6/22/1977
• Doc Name: RECEIPT
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

PLEASE FURNISH SERVICE(S) INDICA BY CHECKED BLC III IIIIII~II"II'll
REQUIRED FEE(S~ID. 999
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REGISTERED N0.
CERTIFIED N0.
sere delivered ~ ^ to addressee I
RECEIPT r
Received the nullrbere6 orticle described below. 1,'~
SIGNATURE OR NAME OF ADURCSSEE (hlnrr elu~ayr b. h!/rJ in) /`-
1
ATE DjLIVERE~
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PLEASE FURNISH SERVICE(S) INDICATED BY CHECKED BLOCK(S).
REQUIRED FEE(S)'PAID.
~Shov€to whom, date and address ^ Deliver ONLY
where delivered to addressee
- - - RECEIPT
Received the numbered orticle described below.
RECISTEREO N0. SIGNATURE pR NAME OF ADDRCSSEE (A'1~++ airuny+ br fiUrA in)
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PLEASE FURNISH SERVICE(S) INDICATED BY CHECKED BLOCK{S).
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where delivered to addressee
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Received the numbered arricfe dercri bed below.
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