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Form 22
(Rev.1-49)           ORDER TO CHANGE ADRESS
                  (IMPORTANT-PLEASE READ INSTRUCTIONS ON BACK)

                Permanent or Temporary until _______________, inclusive
                                               (Date)

 (Print OR WRITE PLAINLY)              DATE___________________,19______
Name or person or firm
 changing address _____________________________________________________

Old address __________________________________________________________
                 (Number)                 (Street) 
New address __________________________________________________________
                 (Number)                  (Street)

_______________________________________________________________________
    (City)             (Zone Number)        (State)
_______________________________________________________________________
   Note-Check below if you guar-   |    Check below whether this change of 
antee forwarding postage for--     |    address is for--
Magazines (box) Circular matter (box) |   Entire family or firm (box)
Newspapers (box) Parcel post (box)   |    Individual signer only (box)

Write signature______________________________________-(Void unless signed)
Chi PO-Job 1-11-1-11-49-14-MM-Emerg   (Patron, or authorized agent, give title)


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