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3 -PART STOCK FORM NO. B-3876 STRAIGHT BILL OF LADING— SHORT FORM ORIGINAL—NOT NEGOTIABLE Shipper's No. S Carrier's Name: Carrier's No. RE I D, subject to he classifica ' ns and lawfully filed tariffs in effect on the of the issue of this Bill of lading, tate at (Date) 19QROM the property dexrnbcd below•, in npparenl good ruder, exi as not I contents wild r'llla lion Ilf conit•tIL4 ,1 packages lmknow'n), marked, consigned, and destined as ahnwn belnw, w'b0i said romp; y ie word rnmpmi}jZ ting mtdr•rstmrd lhnmghnut this contract. as meamnyyr any person nr rurpnr (nrsressinn of the pm rcrty under the roitrnet) agrees Ur carry to its usual place of delivery at said destination, if pn its nw•n tai mad, water Illle, highway mute nr mores, nr within the territory of ita higfnvny a]x•ratimia. otherwise to deliver to annt�mr mnier on the route to swirl destina4mi. It is imitunlly agreed, as to each carrier of all or any of said Imnqyty over all or an)' )mtion br (!niform of said mule to destination. and as to each rariv at any time interested in all or any of said Property, that ,,cry service to Ire perfonnal hereunder shall subject to all the terns and conditions of the Dnmrm Straight till] of Lading set forth (1) In the (nifrrnr 4',eight t•imeiricatkm in ecffect nu the date hereof, if tins na a isor rail -water ahi anent, or (2) in the applicable motor carrier classification or tariff if this is a motor carrier shipment. Slack Shi nprr brmhy rertifirs that he is funili:v with all the trema xnd rlhnd' ions of the said bill n( lading, including those no the therenf, set forth in the classification or tariff which govo'ns the transportation of this shipment. ;uol the said terms and din ianc are rby a4rrod m by the shipper ayflar•rrp fill. himseif mol his assigns. (Mail or street address for purposes of notification only.) S.Iiiect Ur section i or conditions. if this ship- Consigned TO ment is to be delivered to the consignee will teronrse rill the ennsignor, the consignor shall Ag., the fnllow'ing statement: fe carrier slmll not make delivery of this without payment of freight and all shier On Cotler -1 on D livery Shipment Ih rs "C ap ear before consignees name or as of ise p vided i Item 430, Sec. 1. �'• /� , �f�, �h qestination treet� _\�/C( l��\\�\J —City at her lawful cha is Imi iLod County IN State C .% Zip Delivery Route Address* (Signature of rnnsiguorJ (*To be filled in only when shipper desires and governing tariffs provide for delivery themat.) Delivering Carrier Car or Vehicle Initials and No. C. O. D. charges to be Paid by Collect on Delivery $ And Remit to ❑Shipper ❑Consignee If charges arc to be prepaid, write or Street City Statel stamp here, To be Prepaid." No Packages H.M. Kind of Package. Description of Articles. Special Marks. and Exceptions ' o -9 (Subject to Correction) Glass or Rate Check Column Received $ to apply in prepayment of the charges on the property described hereon. ^ r •~�C \iy�\J Agent or Cashier fir (Thr signature Mor acknowledges only the amount prepaid.) Charges Advanced: A \• 1 "The libre containers used for this shipment coif nn to the specifications set forth in the box makers certificate thereon, and all other rewiam.ments of Rule 41 of the Uniform Freight Classification and Rule 6 of the National Motor Freight Classification. - Shipper's t Shipper's Imprint in lieu or stamp; not a part of bill of lading approved by the Interstate .If the shi{{rmom mnvrs licit n own true car — 11'hor the rate is depcnden r value, Ih� require hr hit of ladlinghall state whether it is carrier's nr shipper'. weight lit n•rs r�i'��• •d rates - • s 6 \TC \i I )citing te agreed or declamd value of the pmprrty. The agreed or declared valor of ihr proprrq• v he by spr ii is I hr shipper to br not exceedin¢ ncr Commerce Commission. Shipper, Per Permanent post -office address of shiooer. Per Agent