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Form No. la, <br />n <br />r. <br />.,, <br />ti� TO'W-1F, yUPF.RINTF:ND$NT OI•` THG P•.VI�:RETT R',1TER <br />� • <br />., <br />- ---_ <br />� -- -- -- <br />_� �- i �'�. C- � � <,< _. <br />`� � <br />�Q � \UPlirnti IQa'...�....... <br />�i�.�- . � . G-� � � �-,.*`a-�� <br />nu.. ..... .....................�.�-4��... Svice:. <br />_: ,_ <br />���`. �.: 7:cerelt� .. . ..........� �.................... 190. i' <br />CO\IPAI�Y:� . <br />� I e ebS�nDPI>' for the uxe of a•xter In ncconlnnce v?th the rules nnd�regnlntlons ot tl�e E��erMt q'nter Compnn>�, nnd requent <br />that � .Incli tnp hc Inserte�i in the mafn nt thc pinr� �hoce stntc�L <br />�� � - <br />� i �The pinmUcr who �rlll do mp n•mk Is... ... .y . <br />.. .. ..... ......... ...................... <br />"'��............. <br />.. <br />The o�vner M the premiscs Ix ............. ��. ' <br />. ................. ....... ................... <br />................. <br />Thc eKenils ............................. <br />....................... ... ................. <br />................... <br />......... <br />Thetennnt ix ....... .................... ........................ . <br />........ .................................... <br />The w•nter rert shonld Le chnrge�i to ......................... � <br />� <br />f9cr Othcr �ide). <br />.. , ...� ,..'.......... �.... <br />��� <br />..... <br />Si�nc� ..... .. .. ..�.��......P".. .... <br />.... �Pi�llcnnt. <br />