34 BULLETIN 530, U. S. DEPARTMENT OF AGRICULTURE. 
Form for assignment, to go on policy: 
Notice.—No assignment of this policy shall be valid until approved by the 
company. 
ASSIGNMENT. 
For value received, I hereby transfer, assign, and set over unto ______ 
assigns all my rights, title, and interest in this Policy of In- 
Sn Ghia ees 
surance, and all benefit and advantage to be derived therefrom. 
Witness my hand: this. === sdayeore 2 Sa. a1 1 per 
Approved at ~--___ GHIS= 222 Gaye Oho near se Tine 
, Secretary. 
ADDITIONAL COPIES 
OF THIS PUBLICATION MAY BE PROCURED FROM 
THE SUPERINTENDENT OF DOCUMENTS 
GOVERNMENT PRINTING OFFICE 
WASHINGTON, D. C. 
AT 
5 CENTS PER COPY 
V 
