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- -------- - - - - - --- - - - <br /> - /- ---- - - - - ------- . <br /> . • , Furm \n. 11. �� �.� ' // / �� \ Plicnt No!/��/�� <br /> Vu........../......... .... � Strcet. <br /> . <br /> ... ... <br /> ................ <br /> , � F.t•crett,....�"`.-...... �...��............... 190.?- <br /> TO TIIR 9U�ItiTIi\DS\T OF TIIR ;i\'Is'RIiTT 11'.\T�R C011PArY: <br /> . T ty� el n��i>� ror u,�� �:F� or w�teT In :lccmdNlce w'lth thC rulpq nn4 reF����tlons o[ the Iirci�ctt\\'ntrr Compnnp,and re7��ent� <br /> � <br /> ; that. n .. ......inch taP he lnscrted In the ��t tlie pincr a ce AtC . <br /> , ThS�� �ber a�ho �elll Jo m>' ���nrk la....1/L ......... .'�.� ......................... .............. <br /> �� . ✓.� . <br /> ....... <br /> '� T6e mcnrr ot the P'omisra IF................ �� �""�' <br /> .... ..��.'...p,.I.I._. . ...... .................................... .............. <br /> ne nBem�in............................. ........... .9."?.."'^�'.. .......... , ................... .............. <br /> a <br /> • Tl�r tennnt is............................ ........... .. . ........ .................................... .............. � <br /> �........ <br /> Th� �ent�r rent nhnul:l be chnrsed to..................�................. . ..... �J. .......... ..... .... <br /> • 5�4'ilf�l�.....�!:,.��)...... `73�-�(/.'l/f/I���..��... <br /> ' (Ser Othr.r 31dr1. L/,�.'/.......... APPllcnnt. <br />