79 PRCIPIENT'S name, address. finclualnp apt no.). thy, elate. end ZIP code RECIPIENTS Ideraircotton number 66-0436649' 5 Fishing boot proceeds Ntellcal snd health amp:rots State Copy or Extra File Copy 0011.074104 V.O. • B02C (171:: CHIVALOTTP, .204PiLiEt, • Account number (optima 00804-0970