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■ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />■ Print your name and address on the reverse <br />so that we can return the card to you. <br />■ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />LJ- <br />S� `P 3 o"y <br />A. Signatup® <br />,f/ Q Agent <br />X _ti J . ddre <br />B. Received by (Printed Name) C. pate f DPI <br />D. Is delivery address different from item "1? ❑ Yes <br />If YES, enter delivery address below: &No <br />3. Serjace Type <br />E Certlfled Mail ❑ express Mail <br />❑ Registered GYRetum Receipt for Marchand!: <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />z. Article Number <br />(Transfer from service label) 7108 2133 3939 0 0 2 9 4178 <br />l) <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02 -M -1: <br />■ Complete items 1, 2, and 3. Also complete <br />Item 4 if Restricted Delivery is desired. <br />■ Print your name and address on the reverse <br />so that we can return the card to you. <br />■ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />%L OxL-,w �d�a <br />C-5 r--CL L 114 � C- <br />3 /S OIL ._ S-, 4-/ <br />A. <br />❑ Agent <br />(Printed Name) I C. Date of Delivei <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery-ecWress below: ❑ No <br />3, Sey+I Ty� 4+ <br />I� Cart [k�i arks Mail <br />❑ Registe Receipt for Merchandi: <br />❑Insured Mall C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number - <br />(Transfer from service label) 91 7108 2133 3939 2 9 4 4 1959 <br />'S Form 3811, February 2004 Domestic Return Receipt 102595-02 -M -15 <br />