(See Subsidiary nute OS)

srdI;IiF..ryi?Ftrq-rrrlsq {s-i-rT/rec il+ qT$' $ft-sfl/pq4 a'6 sryo, gftsql q o,n iaq-r +-ri or qm.r

Tc be filted in by the Remitter,t"t!ry sr{i Er.i i6i,fte-drqrRC

To be fitled il Sy ths;psbArrment

,:Officer er the,Tr:eas0ry :6fficbrB.:nimiavral,s oi, #B(

-oooC0)

_c h-

atrco,ls

1

FES trEi;p_ trt>F&E. EE _ilb P sEo,wEtrB[i'*PEs€sE€E(o(o:oi:Ebz "o b E E&&

lEiilFfi

x:.:r,, ,f0,, ,r, rr.Gl. ii:

:9di4.j.,gFr.:.dl'[q

6#

c)0)SE EEE 5 ^ E.Et/) E fcls6hErEfa.=F-,eU-l'FHEBEE

: l: E *a$j-L=l'*tr E d& ts

Arnountloq,

co(t.<Dadb-r ,1r

.a^ .

a!-q€€E€ "OEEEc.l';. l9 >,

SESEootnl€i# E1 IIl-r-l*I

I

IIt6^r-.t- rl

,1,\ Er\\e^\+ Y

s{ *"

;4Rs.

6,.

p

E,'lJameqrq

e:^org

natr-rre'

E-{n^reri

t/\ I

r)' l'-[tcE >-

E

tlJ'?...

r1r

*: *;tu"'4i4sH?* r.+rr' lclr r.jl

f\r .,J-lq I:*l{r vl'.;3

I

IK'?r a:.:

-il i'd.

T1,f;.?:" e-'8"'fr1 A:l}rF

,# *;eir tE &"* iv*P tr! IT-ri'X- lk? s#P"iih

a

) F.upe€s

*#;'#,,,#,.8l rr-;a.surer

Treasury Of frcei'lAgent

q{firTiisc {iriilqUvte ilo s$r

To,befilted in by the.BerrrittbrEfrr qqrwi e-d oi ftg*,g..Gc

8,..{u{ll.c'o..

EF<E6f,

--:,. 4;o6;ri'. '

,'--,'':'r.m-11.'.":.. ;

I ''''.. c .. ...,(I'''--:P: .. ':':;l'.,P:.;... z,lut.o .k

&'s.. tsIc'..o# .I 2 5 .5 ' .' 6' *' ;,7

lJame

aF[,'

sig :q€iur.e

TKIIf;IT

I

Cr\ I.sY t-

t4\ f

iF..,)'

"..P.,fi.r,,

Fs.

..:.F,:.'I.:::-,L.iip j.

,E..: ;pEEr#

.. 'i!: ';.

; 'lg#lff r'.t '

#.'$.E,x;F..-,.,.#H.,.'i',

:

I

:

:

:.<

-

-

\