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<br /> �el�very Atlare55 HaWerR�ud Dexnpnon
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<br /> Instmc6ons . — —
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<br /> lic:-: �5,2[U ��.�'I 10 l3
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<br /> LOAD CUMUL:7IVE a OF PRpDl1CT PRODUCT UNtT p�,qOUNT
<br /> OUAMITY OWMT7V LOADS CODE 0 S Rit' .pRIC
<br /> i.:.53 TOh.i Ec'67 Ii �J4�£5[- ��;r_��"Hi�,1��
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<br /> SUB-TOTAL TAX 71CKET �
<br /> TOTAL
<br /> f�eundersignetlpmmise5�opnyallCosls,mcluamqreaso�aClo nnoP�a�vnaue„i-n,iensci�ot�ss��,ura��cr�.rvrav�sionc�a+ccn:�.<cu�:���'��iii
<br /> w.,wr•No• n�a�..o�o�anu�n.maa.w"qm..ottus[mr��ww�m..�m.r.�n..mou�v+�mev.�..�qm��mu,�.:.
<br /> anorney's loes,incurreU in coilecung any sums owetl. .,,,�,.u,�,,�„c,n,�o m v+.c.<T.,.,w a.e,u.�.yn,„n n n.��.,..,;,.�,n«�i�e.,..w.,,�,..,._,.,2 n n n�,,.�„n m�„�n
<br /> �.0 N...i,�.ry��..r.�m r new o m un r.a..v.s..a.�tra n.�ya.'+m nn n[�usE�wwy mi.m ve.wsm,mm.�ry
<br /> All accounls nol paia w�Ihm 90 tlays ol tlelrvcry will hcar inlcicsi ^j"�"•.",°Wn•"��'""0""""""m'"O"""""'""•°""'•°"`•'°"°'"'•,.°n"'•�'.""'°"mM•.,n.wm...2 i��..a�..o
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<br /> al It+e rate ol 18".6 per annum. mm�c.�ei.uuao�v.� e.v.Y.vr.a e�.e.o�+«�*�r.y u.�.w.a.-�.0 e,..,.�.,,.M aw u�n w mn��er�w.m.N n ym�.y io
<br /> 1'n pmun aml�n e0�1M�'1 yT[nI Nn ry�le 4����)!ry MFm b`en�wn[M M Mwry N Se nW r
<br /> Not Respons���o�or Reaclive Aggregnle or Color Ouality Nr '�Oi1��
<br /> Cleim Allowed U�Icss Uadc at Time AtaMrial is Detiveretl.
<br /> A Sn0.00 Service Charpe antl Loss ol I�e Casn Oi,coum wdl Ue "«'�'J'+ `�� .j�'7��1�f'1 14a ]I 6 iq- 1 F 1�iJ� 19 i d 1- ( � � ��i f'L�:i�51�j3�L��-9qr?S�q�,
<br /> col:edee on all Returnetl Chechs. ':fU� ;(l7 7�1,7#'!7:7:EjI74�.'a L'?:v^.%2 C \d ti;i+7-3q� �L�u:L�..1:?�L.i 1.1-91:7=l:1?n3yT�
<br /> Slandby ��AD RECEIVED BY. O uir�oa¢eo sicruTu�ir
<br /> T�me Initials The sgnaturo a�ove signilies reteipl and ecceptanco ol the i�slod male�ials and acknowleCgement
<br /> al and a9�eemen�to I�e�erms and conai�lons on 1he lace and reverse sitle ol IMs lickel.
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<br /> nuNrver+sn� iaoe BRiCH/OFFICE COPY
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