OCR recovered text quality varies — view PDF for accurate reading.I. DATE - TIME GROUP
| 10. co
TF ) i = = JF r i = io —
Tiles ak We i WT & | £0 - ——
lf 3 n 1 = i Ao i L x i=l # i A 1) i ! he »
ow i LJ i; s | | I
% | 1 { # i il lL i i
ETT 111. BRIEF sums
[I & = i
5 LT Te i NEE
dL 1! — 12 i
Previous editions of this form may be used,