Front:
MODERN WOODMEN OF AMERICA.
CLERK'S OFFICIAL RECEIPT.
Received this... 8.
day of.
1904
from Neighbor.. 4 Iklsou
(Write Nme in full.)
the sums due from him on the following accounts :
$./70
, 190., $. 30
Benefit Fund, Asst No…..26s
General Fund dues to.
Dues to....
190....., $..-
Advance
payments
Assessments No.:
$.
Total, $.
beuoore
Clerk Camp No..770
Form 77
IMPORTANT NOTICE. The By-laws of our Society require
that your assessments must be paid on or before the last day of the
month in which assessment is revied; also, that your Camp dues must be
paid in advance before the first day of each quarter, viż : January 1,
April 1, July 1, Óctober 1.
If same are not paid you SUSPEND YOUR-
Always put name and address in letters, and notify the Clerk
SELF.
whenever you change address.
Rock Island, Illinois.
MAILING CLERK, M. W. of A.,
If not
received, notify
You should receive paper every onth.
ment.
Watch your official paper for notice of levy of assess-
Back:
NEBO
CENT:
THE SPACE ABOVE IS RESERVED FOR POSTMARK.
2.
BK-PM
POSTAL CAR DA
THE SPACE BELOW IS FOR THE ADURESS. ONLY. L.
OF AMERICA
1843
MEKINE
LEX-SOTT
330
Mar C, H, Otelsone
og Seesanal
NO Callifornia
