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For use in 
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connection with the Standard form of StraightBillof Lading approved by the Interstate Commerce Commissionby Order No. 787 of June 27, 190 
X 
/ 
_ Railroad Company Shippers No._ 
^ ^ *•*“ — — — r w . >,-7W* JL ,y 
THIS MEMORANDUM is an acknowledgment that a bill of lading has been issued and is not the Original Bill of Lading, 
nor a copy or duplicate, covering the property named herein, and is intended solely for filing or record. 
Agents No. 
RECEIVED, subject to the classifications and tariffs in effect on the date of the receipt by the carrier of the property described in the Original Bill of Lading, 
At Salt Lake City, LTtah, _ 191 FROM THE MINE & SMELTER SUPPLY CO 
The property described beiow in apparent good oi 
agrees to carry to its usual peace of delivery ‘ 
The Rate of Freight from Salt Lake City, Utah, to. 
.is in Cents per 100 Lbs. 
If. ...times 1st If 1st Class 
Consigned to 
If 2d Class 
If 3d Class 
If 4th Class 
i ... " ■ fa* 'v- 
If 5th Class 
If Class A 
If Class B 
If Class C 
If Class D 
If Class E 
If Special 
per 
(Mail Address-Not for purposes of delivery.) 
Destination 
L ■■■■€ 
/' if ** * 
State of 
.County of. 
Route 
\ 
Car Initial 
Car No. 
No. 
Packages 
DESCRIPTION OF ARTICLES AND SPECIAL MARKS 
WEIGHT 
(Sub. to Correction) 
CLASS 
or RATE 
CHECK 
COLUMN 
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1 
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If charges are to be pre 
paid, write or stamp her 
To be Prepaid.” 
Received $. 
to apply in prepaymen 
of the charges on t 
property describe 
hereon. 
Agent or Cashier 
Per. 
(The signature here ackno 
ledges only the a m o u 
prepaid.) 
Charges Advanced 
This is to certify that the articles in this shipment are properly described, packed and marked, and that all necessary labels have been 
* * „ ~ 
attached to packages, as required by General Notice _j , R- R- 
THE MINE & SMELTER SUPFLY CO., Shippers Agent A25T81 
Per_i 
Per 
2--4J2 Sr U -.IT ED auTOSaaPHIC h~GiSTiK G<£>. , CWi-ArtO 
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