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F-KM No. 1. 671 . �% •� w <br />ALL BLANKS MUST SE FILLED IY / 1/ zz <br />OR CROSSED OUT. ll-01-ntiml \p -7 <br />To 1,1I1, NI'I`IS ItI �PENDUYT olI 7711i LVNJIXTT WATlilf Co.jIp,t N. ISvcrcll, <br />I': _ �il'ecl. <br />I bereb . .. Ixn <br />CmnpnDy, for file purposes nlml 11xWltres xttnted below se of Water ill nc,•erdnnec t'' r <br />• rlllex nnl 1 oils of the lit'ereft Wnttr <br />le work to be executed by.... <br />oTap lr r,,"Wretl. Crory Oul./t 4 '" ---. <br />�%i........Tap to he 111Kelled In the mnln <br />V Y Water Pbeet <br />N ............$nwu lnl. <br />1 <br />...._..... rposex. <br />upillill <br />'—...pinill Felice I, Inside. .. K - StnIl <br />R .. <br />• ..... No. persons in family. <br />.... ... ns Icy.. ." <br />liDThe premises to be owed nx n <br />• ......se-13JI ul.,titi. �/ Sigel..... ..?C'.',"'."'..t.."r <br />