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• � I I �-� <br /> ' Farm Ka l4. -� � l / %/1/� <br /> � � : r�tin \n.......�:..... � <br /> � \n........./.. ...... .... . . ............. SVec[�. / <br /> . .... �/ <br /> .. <br /> RcerMt.............`.�........./,Z.../........... 190.." <br /> TO T11R SI' BRiN7'IiXDP\T OR THIi R1'IiRIS7'T R'.1TI?R CO\IP:1Xl': <br /> i <br /> „ y <br /> f hr� �/a1�Ply for thr� nso of �cater in ncco;dance e�!th the rules and regulntlone nt tho licerou �4nter Cnmpan)'.nn�t re�n<<st <br /> IITt n.... .....incL t: � hc in�rrted in the mntn at ih� pla�•r nM1occ statril. <br /> Th� •pIw bcr w'hn �rill do my �cnrk is <br /> _ .. . . . ......... .................................. <br /> . ... .. .............. <br /> .... <br /> �jy/� r. <br /> Tlie nwnr.r nf thr pi�misre ia............ ✓^'-"y��r � <br /> . ........�.. ...................... .................................... .............. <br /> The ni'enils............................. <br /> ............ .................................... <br /> ....................... .............. <br /> � Thr lrnant le................ G � <br /> ............ ............ ........ ............. <br /> ........................... .............. , <br /> The �eatcr rrne ahnnld he rhnrged to..................... <br /> ...............�.. . ........................... .............. <br /> � Sl�;nal...�!L• :�,��{;y,�i-(.�� <br /> ...�..�. .. ............... .............. <br /> (3rc Olhcr Sidc). Appllcnnt. <br /> / <br />