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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 />J Z ` 7 /Z — //�`L <br />Cr ) � n ) `- <br />e15zC) - �'�5f`7 <br />X )M AAgent <br />by i j'rinted Name) C. ate Delive <br />y I 1 / iM'. <br />D. Is delivery address different from item 7 11 Yes <br />If YES, enter delivery address below: ❑ No <br />3. roe Type <br />Certified Mail P Jkpress Mail <br />❑ Registered El Return Receipt for Merchandi: <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 91 7108 2133 3939 0029 4284 <br />(transfer from service label) <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 />42- 4- 3 "�i2d. Ir 256 <br />C/; -��,,� CO <br />S (i :2. O <br />A. SiTfature/, l <br />1— , /r' -- ❑ Agent <br />x }��/ ,`;r C/4? ❑ Addresse <br />4.,Received byYP hted/Vame) G Date of Deliver <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type <br />I'Certified Mail Q press Mail <br />❑ Registered etum Receipt for Merchandis <br />El Insured Mail / ❑ _C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 91 710 8 213 3 3939 2 9 4 4 1782 <br />(Transfer from service label) <br />3S Form 3811, February 2004 Domestic Return Receipt 102595- 02 -M -15 <br />