Check No. _________. This check to be signed when package is deposited.

In accepting this envelope and contents for safekeeping we assume no liability other than that provided for in the innkeeper's act of this state, which has limited our liability so that in no event can we be liable for more than the amount specified in that act. The employee accepting this envelope has no authority to accept same if the contents are valued at more than the amount specified in that act.

The contents of this envelope do not exceed a value of $_____.

Signature of depositor _________

Do not detach until package is called for.

Delivery only to owner after signature on duplicate check "B" is witnessed and compared.

B depositor's check _________(No.).

This check to be signed only when package is called for and in the presence of the clerk on duty.

Signature of depositor _________

Package will be delivered only to party originally depositing it, whose signature appears on duplicate check on package.