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„ 1'orm \o. 74. <br />m <br />TO THE SI'PIiRI\TIs\llR\ <br />I1� ebv nPPlc Iur the <br /><<1M t a . . �. <br />/ �! An Ilc Ion \o..J.i�:�. <br />l�� y�� —� � � <br />Xu ................... G?tif � . .�.. <br />.......:... <br />\ .... <br />Rr�erclt�.......... 2 .......... SVeet. <br />...... <br />T OI` TIiIi 1'sl'IiRRST {S'.1Ti'.:' Cp\IPq\}': Z <br />.... .....�% .............. . 100.. <br />nec nf e�nter fn acrnrdnnre rclth ihe rnl�•s : .. <br />.......Inch tap be hte�rto�l iu thr md r�Rulntfuns o[ the t'st�ero[t \4'�ter (`o . <br />9'hr il // mofn nt thr pinrr :�bocr =lnted. MPanc� �nd re�nasi. <br />i mDrr n�ho �clll do my rcork Is.//_. � <br />7'hr,.oq�ncr of Ihc prrmicrn ia..... X/ � F <br />................... <br />' ....................... <br />................. .. <br />............v ................. <br />Thr, nKrnt Is ............... ...i,....... <br />......... .................... <br />.............. <br />Thc Irnant Ifi .............. ....� .......................... ................ . : <br />... .......................... <br />.............. .. <br />.... .......... <br />Thr n•:rtrr rent shnnlil L�� chnrKerl to...... ......................... .............. <br />............... ........... <br />fSrc OthnF Fiqrl. .........� ,�.� ....... .............. <br />� .... ... <br />i .... . <br />Signed./......JS?1/, %� ' ...... .............. <br />i......`.� .............. <br />...• ��PPlirnnt. <br />