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House No. 9;??? @W Deposit $ 53 [:0
APPLICATION FOR CREDIT
To Mountain Investment, Inc:
Name A} £37..5344". Lj/m’x’gE/{fi’vfl Age C"

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Number of Dependents :5" Ages @“j 31, :7 ,,, 5:72?

Present (or last) permanent address 71,; /"ag4:,//.