HOWARD R. RICH 
Atlantic, Maine 
% 
Date. _ _ 
Your Name ___ _ . _ _ 
VERT PLAIN 
Post Office- - P. 0. Box ___ 
Express Address ____ 
IP DIFFERENT PROM P. O. 
Caunty - State _ 
Street No —_____- Forwarded by _ 
Amount Enclosed_ ___ Cash S— _ Money Order $ 
Supt.’s Name - T -- Draft or Check S 
STATE HOW MUCH MONEY YOU ENCLOSE 
Quantity j Name of Article 
Dollars 
Cents 
• 
1 f:'T‘ 1 ' - . - V - " ' . 'tv 
' ' 
# * 
' V . 
Amount Forwarded 
SEE OTHER SIDE 
