RECEIVED FROM 
COLLECTED BY 
Hry Co. 
C^a-«"C^oi/\j £o— dJ~-< ^oy^a_a,cS—<. < 3 L/\A- 
CP, 
o4- >3 
0~4^G-v^/ 
When 
Collected 
Oc initial No. . 
When Entered Determ.ned l.y 
3- C . 
REMARKS 
c^t 
3- 
I O ^o 
