Receipt for Supplies, Wells Fargo Express

Front:
1018-D. Agency -------- RECEIPT FOR SUPPLIES. A Wabash-Nehr + ------W6 ----- Agent Shipped AR 19.1019.. via. ----Express Co., Charges Paid Received of the Springfield Fire and Marine Insurance Company the following ---- Commission Auby - Register, with Prohibited List Attached ------Sign -------------------Loss Reports Fire Policies. --inclusive Tornado Policies.- --inclusive Dwelling Policies.--- -inclusive Comb. F. & T. Policies. -inclusive Auto Policies F. & T.. _inclusive -inclusive Certificates -inclusive - MAR 15-1918 Received -- -----191.--- harra ----Agent Please verify, sign and mail to us at once. Do not use Rubbet Stamp or Typewriter for Signature II III i ----- ---------

Back:
09DY'S BIST 0€ UN Springfield Fire and Marine Insurance Co. 134 SOUTH LA SALLE STREET CHICAGO, ILL.