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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 />2. Article Number - <br />(Transfer from service label) <br />PS Form 3811, February 2004 <br />A. Signature <br />� <br />, � ❑ Agent <br />��� <br />X I L L Address <br />B. Received by (Printed Name) Date of Delive <br />D. Is delivery address different from item 1? ❑�.Y-�s <br />If YES, enter delivery address below: o4f] No <br />3. Service Type <br />Efbertifled Mail ❑ ress Mail <br />❑ Registered Retum Receipt for Merchandi: <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />91 ?108 2133 3939 0029 4390 <br />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 />C- C-) <br />t <br />❑ Agent <br />r7l Add. <br />$: Received by (Printed Name) - C. Date Derive <br />i, i r ltr <br />D. Is delivery address different from item A? Q Yes <br />If YES, enter delivery address below: ❑ No <br />3. Sece Type <br />13d Certified Mail ❑ Wress Mail <br />❑ Registered qkheturn Receipt for Merchandis <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 91 ?108 2133 3939 0029 430? <br />(Transfer from service labeo <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1: <br />