Front:
EE
pett
EEE EE
GE EE
EF
FE
FEE FEE
FIE
HEAD OFFICE,
EE
51
MODERN WOODMEN OF AMERICA.
ROCK ISLAND ILL.
kert
Back:
OFFICIAL RECEIPT
OCTIO
Rock Island, II,CT 9 19087-PM
19
Received of addressee and passed
to credit the following amounts:
Benefit Ass'm'nt $
No.
Per Capita
Supplies
Certificate Fees
Total
C. W. HAWES,
Form 449%2 Head Clerk, M. W. of A.
16-C
SLAND
35
PLL:
08
Mr.
4-
POSTCAL
ROCK ISLAND
POST CARD CO
Clerk of Camp No.
ROCK ISLAND
ILL.
Ex Andrews
Chas
ERIES DOP
UNITED STATES OF
266.
La
1706 FRANKLIN 1790
M.W. of A.
Illinois.
403 E Hill st
