| Front Thumbnail |
 |
| Back Thumbnail |
 |
| Title | Carrir's Statement |
| FormNumber | 4245 |
| Revision | c1954 (02) |
| Division | |
| WhereUsed | |
| EKU | |
| LKU | |
| Notes | Two typesetting variants, believed from the mid 1950s: This one simple, smaller font. Title text is 2.5 mm x 37 mm. Last two lines of itemized statement have "Due" in mixed case. Cut to reverse flap slightly different. |
| Source | JohnB |
|