|
i �:,:�,';'.�, ::'„ ` 1
<br /> ,.�, .:::::.:. .;r1
<br /> °"' '"",.", 13UIL1)If'1G � � It11:C1 Utl`lIC/�L f'LUi;rl �li !G �""�
<br /> tr� r.�,w �...../
<br /> V1'Illl.11 IAnll.i.19�11�'..'s LII -�_—'1'IIV111. ._��--'�»-"-
<br /> C � . / �z l cu).: J
<br /> aro k�xls / ;i�� �lr� i�42c�3 353 -G71_: �- 7�
<br /> �AlI1111�IlCiV(il,:�il,lllll IdA1LAlililill�:� 1'li:ll:C , LICI(�SLIlU, �/�
<br /> GI.I1LIIhlCW.lil/.CIUII IdNLAUU111.1�5 1'IIUNG ' LI(;Lli'�LHV. �q�/ �
<br /> � ��-���- l�����r s �S�� - .�f��-F�H�X �/ =3.53 G s•�� .�.�3 -a-�s� �j// 77
<br /> IId1.UlAUIC/.ILOt�11V,G11i11— tA/JLAUUIIIS'• 1'IIVWL UCLNSLIW.
<br /> PI.UtdU�NGCU:�II:/�CIO11 . M/.ILAUJIIL•.5 1'IIUNC IICU�Sf. NO U
<br /> I ---------'- . . -----�-- ----- —__ � m
<br /> ;s
<br /> II'1.11�117 C4/..SOf LYUIIY, ' , �
<br /> �II111L0117G [jf,.UNGII:G �td[CIIANICAL � • , � �
<br /> i _ ` ��nv ❑no�nior� []n�rrnanori ❑ncrnin �
<br /> VALV/.1101!Ui Y:UIIY. y C'(u NP{- �
<br /> I MB �C/.! U711 ❑�CNCE ❑SIGN ❑:�VlllrlltlG POOI lU
<br /> i S �ODO c/ o�,�a�p _ 4
<br /> �ULLUUL'k 190Ar, 7 — —
<br /> I /�io�U �i.�ra9� � •
<br /> vnuru;iu�s� hSEGIA�'ICAL
<br /> I • (r3r „Ti' e � _ irrioiru�i �uC � rnt.—Du�c. []�:uc.
<br /> �.rr.ni.o�e-•�:•ri;,i UFPllUPU1fYIS110P� UELUC/Ofl nncu •— _-- s�s
<br /> ru�nc��iisi ' /f � `f�$ —
<br /> f:0. TVP� or roi�u_•,u:;
<br /> LOT C!OCY._=0F B��✓!rw -e�� y - --- o.ui co>m. u�:��s-�i.r.e:.. -- 5 - F�i
<br /> � • —---------
<br /> 7s � �/�, nt n.ici nni imi�rnr�-i�N. [r..
<br /> _ C.olt L 115_�i n. fA. �
<br /> ' � � � GI.; PIf�!IIA.C.U::�7^,-IONHlGcCn. —�--
<br /> , �.
<br /> 1 pflCCl):Jfl $1'S:C'.S-::.T.0 '.: CA. -- 1 —
<br /> JUO ADUOL55 Pl4t L Mf rJ L IIS-f1.T.U. 6/ - -_-"---f
<br /> —'_7'_
<br /> 00 3 —• C�/ • ��� ��.�,—,,[nr[n:-r..,.u. ,., _ 1
<br /> PIUF/BIWG • cvr,ro;i:,n�_r. ccr�i.rr•.s ---�—
<br /> �\1 '�t-P . CLO111FSpnYifiS ---�
<br /> �_ _'__ �—
<br /> � . vU:lll:.T10:� 1l.1! �
<br /> �. ' fl.\HGI' IIOUII �
<br /> �r.m nn::nur:�,;��r.ir- c.F.n�.
<br /> 1:0. Ti-_ OFfIY.tln:I: cltlrUd F[li ----
<br /> Finitr�-ci iioi�[ii— —�s �— u+ai:cnnto�� �
<br /> —i�:�iiic_ -- _ � .
<br /> li.ViuO��r i.i.:Cil Uh5�k� �� �
<br /> SIIU_.`^ i1 . �-- —
<br /> — rnic���__. ... r,nr.�, �-- -� s�utoin� s �--
<br /> — r.c.�c::.��-:� —I— ---
<br /> -- 1./.UI:'sF•. :�AY -- �'-- YlHf.!IT 5 --�—
<br /> — iorr,�r[[ ; �
<br /> _ ti.trii;:_r .>��en � i�us rer��n !.tcu:+r, r,u�.� :rcu voin ir r:oiu:o:� cu',tnuc•
<br /> _ �vnrrn �_•��!n ilU1! l,UtliOfll;Fb �s �:or co�.:•a!��:c[o :•:n�ur� I.'7 f�:.YL. Oil ll'
<br /> VIUN4� •. • --��--' Cnr:J'ff:UCl'tOY pfl C:O11✓, �� �us:e,:uro on r.nnr.nn�:to ron n
<br /> — nrr:, ,•.; ;,uvT:,,.i 1— rcniva or 1:0 UAYS AT nHl' LI.L :.FTUI�vGitC I.cor.:•.:cnceu.
<br /> —ii`co;;=- .�_nniv:,:�n �-- i ucnrnv crr,tirv nir,r i ��nvc nrr.n nr:n cr.n�nr:eu nus nr.
<br /> vnciiv•: _;:,��n�s �—�^ rucniror: nr:;� rr;ocirnr !':.'ICTpCCTI'.UfAIJDCpl�f1!f,T. Al.I
<br /> --�--' PlfpVi5iOK5 Of LA'.\5 A':U [1RU�1:l.r:[CS GUVf(v:l:�:r� TIuS TYPI'
<br /> iI:UUi� l.:t :__HlJl:l_:AUfll$_ Of 1'.'OIU: 1'fllL �� LD�1PLIl U '::I1H P:I�ET1�[11 $i'[f,lf 11-0 IIEi11!IIJ
<br /> SIKI: Ki=Jli.e..:i.\II. LTC.) �—" U4 NOT. 111@ GIil.1:TIt:G Ut: !. Yi H`.:IT DO:$ fiUl .i`l11::U'.!E TO
<br /> — — � GiVf /.UTIIORI:r t(� V�Otf.T4 GR Ct.�:Cll Ti�° r�i Ovi:�U::SOF
<br /> h:lY OTIII.fI ST.V I on �oc:.�_ ir.�: r,C:Ul.\TIM1G �U::SiIUGTWN
<br /> __{_. OR 111E PLllf 0111.7At�CE OF Cpt.'S1'11VC1IUfi.
<br /> SUpSVThL
<br /> ' Pfll:dlT 5 � • l . ,
<br /> TOIAI. lCC � !—� � / / -�
<br /> � � � �
<br /> CITY 06r !iP:T.O:; TI17S I,It�E s�cr,n�V'll-oi corzn;.uinnonr,u � r.cc�:i �nt
<br /> tiIUI: YNtU�Sii+CA SIIILULLIGACI: 1{CAf/1'AI:DSE7GACr. I'lAUC11tC1: P;Uf.tllkfl fLANC1ICCY. PEf
<br /> �
<br /> � FCG IIECCIPT NO.
<br /> UiG%Oh'L LO7 AIIC.A VACi\Nl SI1 C �� �('� I y ' oU •
<br /> • Ons Or7o rr:�^ vnwnrinu in:
<br /> 4��rcor con.i— occurnr�crcn�,ur i:n.-oi U\tiLLLI1�G ' T�-
<br /> UI�I15 1
<br /> I
<br /> a' .� y �
<br /> 512. OI IILUG. NU.UI' SIUIIII.y IdA�..VCC. LUAU OUIlU1NG 5��� .
<br /> � riu�.minc . ' !
<br /> I'111L 2P1:1. UAilA1LfJ1 Iili1 :.�'11i1ir.11lq: J
<br /> � 11111'.IIIIf.0 1
<br /> �.IYI.S ❑Np �.IfCIIANICAL I
<br /> 1
<br /> ':P f f.l n 1 00 nTi nq.V::: . I
<br /> - — nmr.n �
<br /> _ =— i--
<br /> — � rcrrr�i�' src.ao�lel 1
<br /> --._ .-- -- -- ---��—`...._.
<br /> _ �_ . ____'--` ' 1(�TAI. — -- , . . t) �
<br /> _ � 1
<br /> 1•I lil.ul Vn� ulnl��uJ •
<br /> • ^- —'-------"'—'•—�-- 1'+IiullYwl'I.lil.l' vn1111N-1'../ 117l1���:C�•l�C1.17111SI: vqVflPf.11nllT
<br /> ... .. ........_.. ..._.._ ..._..��.�..__. . . . _........_. '
<br /> n�nrt.�ir.��hi�ib:�� �n�.un��iuer niu�nUiu�li�.�w.�.11n '
<br /> I . ._ . ._- __—_ —____. . �. ___-__.— _ . _ . -__.._..__-. ._.. - ._.
<br /> .... . .._. . . . .. . . _ ...... .._.. .: ..: ......__. 'i r '
<br /> .
<br /> t - ' -
<br />
|