U.S.S. HENRICO SHIP'S STORE ORDER FORM

Make check to:     U.S.S. Henrico Ship’s Store

Mail to:   Jim Ralston

                1296 280^TH Avenue

                Delmar , IA 52057

 Click on File and Print on browser and mail this page along with your check to Jim Ralston above.

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Name:                                                                                                                  

Street                                                                        City                                   

State                Zip                      Phone #                                                          

Item Name                                                  ,               @ $                                  Total $                

Item Name                                                  ,               @ $                                   Total$                

Item Name                                                  ,               @ $                                   Total$                

Total amount enclosed: $         .      .

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Property of the USS. Henrico APA-45's

Reunion Association.

12/22/06 01:28 PM