LEAVE BLANK 
Burns Gardens 
1707 77th Ave. North O.N. | 
Minneapolis 12, Minnesota 
Date 
Name 
Address 
Pao: State 
Print your Name & Address Plainly. Remittance must accompany order. No C.O.D. orders accepted 
We - do - not - substitute - unless - requested - to - do - so. Please list one or more alternates. 
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