BP5349~ J
~. .
B~JILDiN~G P~i~~llt1'; A~P~iC~TlO1~
Jurisdiction of City, of Blair, Nebraska
' 218 South 16th Street
Application Date: ~~ r~~ 1 ~~
Blair, Nebraska 68008
(402) 426-4191
Permit 5 3 4 9
N~
Issue Date: f ~'" Permit Fee: $ ~ t~ ~~~ ~ ~~J
JOB ADDRESS
LEGAL
1' LOT /
l ~J B~• TRACT
I ~ ~' 1 ~--
~l /
^ SEEATTACHEDSHEET
DESCR. G~ .
OWNE MAILADDRESS ~ ZIP HON
NTRACTO
3.
~ MAILADDRESS ,~ , PHONE B NSENO.
~
3~
~
~ ~l
C
~~
~
e, ~~.-
~ ~-~-., _
~
Q
4. USE OF UILDING ~ ~ ~ ; _
~ ~ ~o'"ZB7y l
5. Class of Work: ~y ^ ADD ION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
: ~
~
~~ ~ c_ .
Q
7. Sq. Footage of Structure fmd~dlRg Bas9m9ntanacareg9):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~
laln: Floodway Yes No ^
10
FIOOd Dev. Permit Elev
Cert.
.
p
Fringe Yes^ No ^ BFE .
11. Current Zoning: ~ ~~
12. State Fire Marshall Required: Yes ~ No^
13. Special Use Permit Required: Yes ^ No
14. Variance Required: Yes^ No'®
15. Minimum Setbacks: Front ~~ Side ~ Rear
16. Sidewalk Required: Yes No ^ Waiver Approved _
ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I achnowledge that payment of the
building permit application fee does not constitute issuance of this building permit. I further
agree that construction covered by this permit application shall not be commenced until I
have received a copy of this application form signed by the Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codes~ordinances of the City of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 180 days
jor~is n)ot completed within 2 years o to of issue.. 7
G(/0/ ~- 5 ~ ~ r ~ ffj Zz.-~jJ
SIGNATUR OF OWNER~CONTRACT AUTHORIZED AG DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attached Complete Plans Attache
Approximate Com letion Date
Inspections Required and Fees
Utilities
Sewer Tap~(S~~ -,d~r~` Water Tap / ~~~~`~ " `~%~
Sewer ~ Water Service ~ I o ~ U ~ -.~~ m
y -r
Septic Remote
~ z ~ ~ ~3 Building ~t y~ f Ff ~~ "~ ~ ~~
,~ ~-~=~-9~t ~.~.1
~~. 3 - ~3 ~ .3. g
Footings
~ Drywall ~
(p.7.~ ~{~ (Z- ~- 1~ ~~_ (before finish) ~'~
Framing/` "ZO-~~~ ~'°J~ ~~`~ Final ~/ # I - ~~ z~' 4~1 ~
~_ "2~ ~'`~~~ Electrical
Rough-ink ~I:~~~ - _Z~~~ Fixtures
Final ~~ ~~ ~ ~ ~~~`~(~~ permanent Service ^~ ,! ~ ~ _ ~~
Temporary Service ~ '~~ ~"~'~~
r~~ ~ , c~~ j Mebh pical
Rough-in ~ u-, ,J "ZA ~~C / ~.~,e,. -
Final t•_r ~.w~~,ul-ew"n Jr~
Plumbing. <J-~Y
Ground Work 3 ~ -~ ~ :3~~'y~I ~~~`~
Rough-in .~ ~`~~~°~~~fFinal ~~'~~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:
i
PRTG: Blelr, NE / Rav. 10/91 -
BUILDING INSPECTION REPO
CITY OF BLAIR WASHINGTON COUNTY
--- ,
LOCATION OF IN ECTION:
NAME OF OWNER:
CONTRACTOR_
DATE INSPECTION REQUESTED; ~~ 9~
TIME INSPECTION REQUESTED; ~ ~~ PEF
./~-
TYPE OF INSPECTION REQUESTED:
BUILDING:
FOOTING FRAMING
--- DRYWAL
NAL
UTILITIES:
SEWER TAP SEWER
SEPTIC
WATER TAP WATER SERVICE
REMOT
ELECTRICAL:
ROUGH IN: FIXTURES
~- FINAL
PERMANENT SERVI -~
TEMPORARY SERVICE
MECHANICAL: RO IN A\C ~_
--~ FINAL _
PLUMBING: GROUNDW ~ ROUGH-IN
/ -~_ F I NA
RESULTS OF THE INS ION: PASSED ~/
(SEE NOTES) F.
NOTES\REMARKS: n ~ ~ d
INSPECTOR:
DATE INSPECTION MA ~ j ~3
CAL LED OPPD\ CONNECT SERVICE:
WAN T OFFICE STAFF LL OppD~ _
TIME:
YES - ~
BUILDING INSPECTION REPOR'
_~CITY ~F 'BLAIA, WASHINGTON COUNTY
LOCATION O,F INSPECTION: IDS ~~~~e~~ '- YVG`
NAME OF OWNER : T~~ W~ ~ 7~~ f~ 1~'~~~~~~ CONTRACTOR_~!
DATE INSPECTION REQUESTED: I~~ ~~ PEF
TIME INSPECTION REQUESTED: ~'2'lv`Cl_j
TYPE OF INSPECTION REQUESTED:
BUILDING:
FOOTING ~ FRAMING DRYWAI
FINAL
UTILITIES:
SEWER TAP SEWER SEPTI
WATER TAP WATER SERVICE REMC
ELECTRICAL:
ROUGH IN: FIXTURES FINAL
PERMANENT SERVICE TEMPORARY SERVI
MECHANICAL: ROUGH-IN A\C FINAL
PLUMBING: GROUNDWORK ROUGH-IN FI
RESULTS OF THE INSPECTION: PASSED ,(SEE NOTES)
., I
NOTES\REMARKS: 1`) /~;-'~ • ~~
j -. T
INSPECTOR: '~~~1J,~ ~C ~~~-~--~.~~~.~U," `,
DATE INSPECTION MADE: ~'{~~~~~ `f'~3 TIME:
CALLED OPPD\ TO CONNECT SERVICE: YES
WANT OFFICE STAFF TO CALL OPPD\ YES
~~, - ~ ~ - B-U~ILD~,NG PER~IVLI~, APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
' Blair, Nebraska 68008
(402) 426-4191
CATION
5661
Permit
Application Date: ~ Z' ~- ~ ~ Issue Date: ~z-~_ Permit Fee: $ Z -~~
JOB ADDRESS I U`t,~-~ `~~~
T , \
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
OWNER '~ ~ M DDRESS Zlp PHONE
3 CONTRACTOR AILADDR PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ~ NEW
^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
I
6. Describe Work: ~ -~ C~- (~ , ~ (j„ I ~ ~- ~; ~ ~, ~ J
7. Sq. Footage of Structure (Induding Basement end Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodwey Yes^ No ^
1Q Floodplain: Fringe Yes^ No ^ Dev.Permit
BFE EIev.Cert.
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes ^ No ^
15. Minimum Setbacks: Front Side Rear_
16. Sidewalk Required: Yes^ No ^ Waiver Approved
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
i NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I acknowledge that payment of the
building permit application fee does not constitute issuance of this building permit. I further
agree that construction covered by this permit application shall not be commenced until I
have received acopyof this application form signed bythe Building Inspectorand stamped
~~ 'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codes~ordinances of the City of Blair and the State of
Ne4taerKa. I understand that this permit is void if work is not commenced within 180 days
r is t completed ithin 2 years of date of issue.
~~%~
SIGNATURE OFOWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
R
h
i
l~~ ~~~ '~
~~
oug
-
n /-
Fixtures
Final ~~ (~-~ ~ ~~3P re manent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ~ ~ e
POUNDS PRTG: Blalr, NE // Rev. 10/91
~ t
~' ~ BUILDING ,INSPECTION REPOR
1/ CITY OF BLAIR WASHINGTON COUNTY
LOCATION OF INSPECTION: ~~ ~~c%~ ~~~~/'/~/~
NAME OF OWNER : ~-Ui~- ~1)U~.17"~1~i~iS CONTRACTOR G
DATE INSPECTION REQUESTED: Jz - ~' `h PEI
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:
BUILDING:
FOOTING FRAMING DRYWAI
FINAL
UTILITIES:
SEWER TAP SEWER SEPT]
WATER TAP WATER SERVICE REMC
ELECTRICAL:
ROUGH IN: FIXTURES FINAL
PERMANENT SERVICE TEMPORARY SERV]
MECHANICAL: ROUGH-IN A\C _
PLUMBING: GROUNDWORK ROUGH-IN
RESULTS OF THE INSPECTION: PASSED
NOTES\REMARKS:
FINAI
F]
(SEE NOTES)
INSPECTOR:
DATE INSPECTION MADE: J~ ~~.~ TIME:
CALLED OPPD\ TO CONNECT SERVICE: YES '~
WANT OFFICE STAFF TO CALL OPPD\ YES
BUILDING INSPECTION REPOP
CTTY OF BLAIR WASHINGTON COUNTY _
LOCATION OF INSPECTION: -~ ~ ~
NAME OF OWNER: c-~ q CONTRACTOR
DATE INSPECTION REQUESTED: J~ / ~--~ PEl
TIME INSPECTION REQUESTED: ~'CJ
TYPE OF INSPECTION REQUESTED:
BUILDING: r ~
MECHANICAL: ROUGH-IN A\C FINAI
PLUMBING: GROUNDWORK ROUGH-IN F]
RESULTS OF THE INSPECTION: PASSED (SEE NOTES)
NOTES\REMARKS:
INSPECTOR:
l
DATE INSPECTION MADE:
CALLED OPPD\ TO CONNECT SERVICE:
WANT OFFICE STAFF TO CALL OPPD\
FOOTING FRAMING DRYWAI
FINAL
UTILITIES:
SEWER TAP SEWER SEPT7
WATER TAP WATER SERVICE REMC
ELECTRICAL:
ROUGH IN: FIXTURES FINAL
PERMANENT SERVICE TEMPORARY SERV]
TIME:
YES
YES
BUILDING INSPECTION REPOR'
CI~'Y OF BLAIR WASHINGTON COUNTY
LOCATION OF I NSPECT I ON : ~-srto2-s_:d~c s~,
NAME OF OWNER: CONTRACTOR
DATE INSPECTION REQUESTED; ' Z a PEP
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:
BUILDING:
FOOTING f ~ FRAMING DRYWAL
FINAL
UTILITIES:
SEWER TAP SEWER SEPTI
WATER TAP WATER SERVICE REMO
ELECTRICAL:
ROUGH IN: FIXTURES FINAL
PERMANENT SERVICE TEMPORARY SERVI
MECHANICAL: ROUGH-IN A\C FINAL
PLUMBING: GROUNDWORK ROUGH-IN FI
RESULTS OF THE INSPECTION: PASSED L/(SEE NOTES)
NOTES\REMARKS:
INSPECTOR : ~~J~.S-
DATE INSPECTION MADE: IZ~/'oIg 3
CALLED OPPD\ TO CONNECT SERVICE:
WANT OFFICE STAFF TO CALL OPPD\
TIME:
YES
YES
~ 1 f ~
/~ BUILDING INSPECTION REPOR'
.~/ CITY OF BLAIR ~ WASHINGTON COUNTY
LOCATION OF INSPECTION: 10 ~ ti ~.
NAME OF OWNER: ~~ CONTRACTOR
DATE INSPECTION REQUESTED: 1_ ZI~~9 3 PEP
TIME INSPECTION REQUESTED: !~ w~
TYPE OF INSPECTION REQUESTED:
BUILDING:
FOOTING r~ FRAMING DRYWAL
Z ® FINAL
UTILITIES:
SEWER TAP SEWER SEPTI
WATER TAP WATER SERVICE REMO
ELECTRICAL:
ROUGH IN: FIXTURES
FINAL
PERMANENT SERVICE TEMPORARY SERVI
MECHANICAL: ROUGH-IN A\C FINAL
PLUMBING: GROUNDWORK ROUGH-IN FI
RESULTS OF THE INSPECTION: PASSED,, (SEE NOTES)
NOTES\REMARKS:
INSPECTOR:
DATE INSPECTION MADE: ___~~ < TIME:
CALLED OPPD\ TO CONNECT SERVICE: YES
WANT OFFICE STAFF TO CALL OPPD\ YES
,~ BUILDING INSPECTION REPOR'.
~ CITY OF BLAIR WASHINGTON COUNTY
LOCATION OF INSPECTION: ~~~~ ~~R--~-~-`
NAME OF OWNER : `1~(~~'~R.~Z- ~y`~-V=~- CONTRACTOR
DATE INSPECTION REQUESTED: ~~ ~~~~~-~ PER
TIME INSPECTION REQUESTED: fS=~~~~ ~'1
TYPE OF INSPECTION REQUESTED:
BUILDING:.
FOOTING _~ FRAMING DRYWAL
~, FINAL
UTILITIES:
SEWER TAP SEWER SEPTI
WATER TAP WATER SERVICE REMO
ELECTRICAL:
ROUGH IN: FIXTURES FINAL
PERMANENT SERVICE TEMPORARY SERVI
MECHANICAL: ROUGH-IN A\C FINAL
PLUMBING: GROUNDWORK ROUGH,-IN FI
RESULTS OF THE INSPECTION: PASSED V (SEE NOTES)
NOTES\REMARKS:
INSPECTOR:~f
DATE INSPECTI/ION MADE: Z 2 TIME:
CALLED OPPD\ TO CONNECT SERVICE: YES
WANT OFFICE STAFF TO CALL OPPD\ YES
Rod Storm
City of Blair.
City Hall
Blair, Ne. 68008
Dear Mr. Storm: .'
This letter is to advise you that the Fox Ridge Apartment project located
at 311 North 9th Avenue, Blair, Nebraska.
is an Equal Housing Opportunity complex open for all to apply. We
are pledged to the letter and spirit of the United States policy for
the achievement of equal housing opportunity throughout the Nation.
We encourage and support an affirmative advertising and market program
in which there are no barriers to~obtaining housing because of race,
color, religion, sex, national origin, familial status or handicap.
We invite you to send any who may need housing to inquire to the
manager: Kate Buxleson
Phone : 426--4010 (1 - 5 ; 30 Mon -- Fx~ ~
If you have any questions, cio not hesitate to contact us.
Sincerely,
~,.'W. 7raxstmuas, ?x~
11322 Dmxnpvrt
Omaha, JIBE 68154
We request that you display the enclosed poster in a conspicuous place.
EOUAI HOUSING
OPPORTUNITY
~~ ~ BUILDING P~RM~T APP~ICATIOfV
_ ~ ~ ~ Jurisdiction of City of Blair, Nebraska ,
. 218 South 16th Street
` _ Blair, Nebraska 68008 5 7 21
(402) 426-4191 Permit
l~
Application Date:.~~~ ~ ~' Issue Date: ~ -c~c~'~ " 1 Permit Fee: $ '~ 5~ ~(~
JOB ADDRESS.
LEGAL
1 ' DESCR. LOT NO ~ I ~ BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER MAIL DDRESS Zlp PHONE
3 CONTRACTOR ~ ~ ~~ ~ / ILADDRES~ ~ ~~ /,~D PHONE ~
v J 7~ LIC~ S,E NO.
G~
4. USE OF BUILDING
5. Class of Work: ,-NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
7. Sq. FOOtage Of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodwey Yes^ No ^ Dev. Permit
10 Floodplain: Fringe Yes^ No ^ BFE EIev.Cert.
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes^ No^
15, Minimum Setbacks: Front Side .Rear
16, Sidewalk Required: Yes ^ No ^ Waiver Approved _
APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
" `j NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I achnowledge that payment of the
building permit application fee does not constitute issuance of this building permit. I further
agree that construction covered by this permit application shall not be commenced until I
have received a copy of this application form signed by the Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codes~ordinances of the City of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not co pleted within 2 years of date of issue.
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
oa''~ Utilities
Sewer Tap ~I rJ ~ ~~'~_ Water Tap
Sewer T pB
Water Service U
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough•in ABC
Final
Plumbing r-- ~~'~VY~
Ground Work oa
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in ~ ~ ~ ~' 6 ~ o ~ ~ final ~~ ~~" 0 ~
a-~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv,
POUNDS PRTQ: BIeIr, NE Rev. 10/81
~, _ e
,~
__ ~ ~
~ 5~ - 3 ~~ X110 ~ ~ q~e I - ~ --
BUILDING PERiVIIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
Application Date: '~~~s ~~ `-f Issue Date:
ca
Permit Fee: $
JOB ADDRESS '
LEGAL
1 ' DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
2, OWNER / ~ ~ - , I 1 MAILADDRESS ZIP PHONE
3. CONTRACTOF~ ~~ MAIL A~~ `~ ~ I S•~ ~ PHONE f ~ ~ LICENSE NO.
4, USE OF BUILDING
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: FI°Ddwey Yes^ No ^ Dev. Permit Elev. Cert.
Fringe Yes^ No ^ BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes ^ No ^
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I achnowledge that payment of the
building permit application fee does not constitute issuance of this building permit. I further
agree that construction covered by this permit application.shall not be commenced until I
have received a copy of this application form signed bythe Building Inspector and stamped
'APPROVED'.
I herebyagree to perform the proposed work in accordance with the specifications setforth
above and in accordance with the codes~ordinances of the City of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not completed within 2 years of date of issue.
OF OWNERICONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF
Footings
Framing
Drywall -
(beforefinish)
Final -
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
~,~ Mechanical
Rough-in ~ ~(J ` q~C <~C~ b ~
,~ co
Final
Plumbing
Ground Work
Comment: Approved B .
5793 __
POUNDS PRTG: Blelr, NE Rev. 10/91
.DER) I DATE ROUgh-m Frnal
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
- ~,:
ti
A ~$ ~ ~ ~~NEBRA~~A ~STAT~ ~'1RE
MARSHAL
, - 4,
. Q.
IIII
Plan -Rev~e~nr -
I
a
-
,
o ,,
,e A
Plans Reviewed By: tel: Main Office ^ District "A" ^ District "B" ^ District "C" ~RAS`~
~ yDATE ~ r'
TO: RE:
kohe.~^-t. tad. ~ric~~l & ~w~st~~ . ~ ~r.~:~~i~,~~~ ~.~ i~~za,3e II
~ l~%2~ ~~~'lcr S~~et~1i. FJ?~ F;2.c~,c~~ ~~~ia~~.~tt~z~t~:
C~~1tc~. F1c'-:. y L`~.N; 6 ~ 14 ~4 1 G ti: ~ ~ x ~ ~ f.
~31a.ir, 2T~~
i
.-
-. -.
i
I ~ Preliminary Plans and
~ A Review#orCompliance ~ Resubmit forApproval
',, Specifications Reviewed with Handicapped _
(See remarks) Regulations isincluded -
Final Plans and ~ Shop Drawings Approved 0 .Materials Reviewed
Specifications Approved (See remarks)
I (See•remarks)
REMARKS:
i:c e ~~ ~~x C:~~es
SIGNED: ' ~~:- r~~-
~~
i
~ ~~~
`~ ^ Main Office ^ District "A" ID District "B" ^ District "C"
~'°~ 246S.14 246S.14 438WesfMarket 200 South Silber
Lincoln, NE 68508-1804 Lincoln, NE68508-1804 Albion, NE68ti20-1241 North Platte, NE 69101-4200
(402) 471-2027 (402) 471-2027 (402) 395-2164 (308) 535-8181
- SFM-75a (Rev:6/93)
WHITE-Recipient YELLOW-FireChie( PINK-Deputy GOLD -OlficeFile -
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