Amount Brot. Forward | | 
eee beens bees! pee! eed pee! peated teed (eed femmes lemme) (eee) fe a es a Sy ees pee 
| ES |S S| NS | | ee emacs | eens | ences | ees | ameeeenens | cee ¥ eeeereeene * cere | eenctsecnnens | eonnnoenmmenens 
on 
—— ee 
—— 
Iowa State Sales Tax | | 

Total Amount Enclosed | 
Please give names and addresses of friends who like glads. 
