Receipt for Supplies

Front:
1018-D. -- ------- -- ----- ------------ RECEIPT FOR SUPPLIES MR.J.M.BIBLE, AGENTS 5597 Agency ---------- VERONA, ----- Agent Shipped .. via.----------N-E. ----.NLEBR., Express Co., Charges Paid Received of the Springfield Fire and Marine Insurance Company the following ------ Commission - -----------Register, with Prohibited List Attached ------Sign-----X ---------Loss Reports Fire Policies--- ---inclusive Tornado Policies.--- _inclusive Dwelling Policies Linclusive Comb. F. & T. Policies.-- -inclusive Auto Policies F. & T.. - inclusive -inclusive Certificates _inclusive 18-Tomado-ador, 100-115 Received...! W --- A ----- Agent Please verify, sign and mail to us at once. Do not use Rubber Stamp'or Typewriter for Signature II II II II -- IL..---

Back:
ASROSTAGE Springfield Fire and Marine Insurance Co. 209 WEST JACKSON BOULEVARD CHICAGO, ILL.