Receipt for Supplies 1658

Front:
M BecerT FOR SUPPLIES You have 192 to 195 imel 1018-D. RECEIPT FOR SUPPLIES 1658 Razan, Nob. ----------- ---- Agency ----- Agent Shipped .. ..via -----Dm- ------Express Co., Charges Paid Received of the Springfield Fire and Marine Insurance Company the following------Commission_ ------- Register, with Prohibited List Attached ---- Sign --------Loss Reports K5 Сиела Fire Policies-- -inclusive Tornado Policies.- Linclusive Dwelling Policies. Linclusive Comb. F. & T. Policies --- Linclusive Auto Policies F. & T.. Linclusive --inclusive Certificates inclusive --- --_td Received ---- - Agent Please verify, sign and mail to us at once. Do not use Rubber Stamp or Typewriter for Signature

Back:
6 PM 1918 VEBR RECEPTO APM || -1918 info .INS. Springfield Fire and Marine Insurance Co. 134 SOUTH LA SALLE STREET CHICAGO, ILL.