Modern Woodmen of America 201 North 8th street suite 210

Front:
188 LLL 900 AUDITING AND BOOK-KEEPING DEPARTMENT, HEAD CONSUL'S OFFICE, M. W. OF A., LINCOLN, NEBR

Back:
Form 449-12-08-160M. OFFICIAL RECEIPT Rock Island, Ill., MAY 23 1910 Received from the party to whom this card is addressed, and passed to credit, the following amounts: Benefit assessment $ کی N251 9400 Per Capita Supplies.. Certificate fees Total Omstawre Head Clerk. M. W. of A. This series of 14 Head Office vie 8 can be obtained for 20 cents. Supply Department, M. W. of A., Rock Island, Ill. ROCK 25 12-35 PM 190 NO.14 M. W OF A. SERIES Mr. W OF A E. Slade 6348 Clerk of Camp No...... Chgo Province ONE CRINIU M. W. of A. illinois. ena av ROCK ISLAND POST CARD CO., ROCK ISLAND, ILL.