ry X Date: 11 / 7— ID Check here it there are additional account signers on reverse side of BRANCH COPY. THE ABOVE INFORMATIONAND (NO.) Prim Name lira tan-) SIGNATURE(S) WERE VERIFIED BY: Initials Dem. No /Br. No.: / 3 41 Retain earn in branch for one year alter accoum doses.Then send to Pawling for ad