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C. B. F~m I <br /> <br />COMMONWEALTH OF VIRGINIA <br />COMP£N~ATION BOARD <br /> RICHMOND <br /> <br />ExPENsE ¥OUC~' I~OR LOCAT, <br /> <br />NAME <br /> <br />TITLE <br /> <br />:) <br /> <br />AMOUNT <br /> <br />Premium on off/c/al bonds, itemized in detail as follows: <br /> <br />Portion Payable b.y Stat. e .:..:..: ............ $ ~ <br /> <br />to <br /> <br />Total all purposes <br /> <br /> <br />