vez,wraz L" '2_ o I manillas! the sloternents made by ma on this form are true. .. Mont SlanatureC 6 alileCI (1 15 CA 3112-- Pogo Taal 12./11 LiS Li, 4, 4, A'''"F"''''' buy 1 1 i f (q 1 3 II:A rebate Date e t ej., 4$12 8 3 3 0_1 -o- ur) a: o lY u_ O 7 V72a. 7'3 7 2 O EFTA00