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<br />STATEMENT <br />FROM .111/ Ii e W //1//1 11/ ~ Cc/?/s7duc7~ <br />37//6 Lvmo It.~ J1 vt~ Z - 1/,(/05 <br />OA.W, d ,s 19~ <br />111 ~ ({ ~ (2 fll YUONd " <br />lelVlVc~r <br />FAt 3~)5-V() <br /> <br />TO JJ1;( -f /J1;( ~ <br />ADDRESS ~/,5 / <br />, I <br /> <br />CITY 2-f{ I' (/s <br /> <br />TERMS <br /> <br />OR~DER NO. <br /> <br /> /JdJ~ "iJ 9k//' <br /> ~/JJ~ (/~~;t.~ ~ "" J <br /> T:: ~/~~c1]7L' .d..e-uz. ~p- ,~ ~~OO ~ <br />. 1 , <br /> "-' I Y <br />/' "(--... <br />" \ -:t::::>"'<" '.Ie .'\. , <br /> \ " I ~ , <br /> CA..-........-"-~ 0. _ /, <br /> I '" " ~ -- <br /> I <br /> I <br /> <br />~ ~e-,t;h <br /> <br />HEAllTZ INC:GARLAND TX 75041 <br /> <br />I ...Scribblet ex#- I <br />