DO NOT LOSE THIS LICENSE. A DUPLICATE WILL COST $1.00 
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Note : — Go fo an Examining point if you want restriction 
removed. 
CHANGES OF ADDRESS 
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Name_ 
S'/ 5o S v /3^^f /<™ r*? 
Street and number /- ' & ri ‘l <5 
City. J/ /n/ef5 / 
Street and number 
City 
If you have changed you 
above and notify the Registry 
t-i 
address, write the correct one 
writing. 
