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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 />e r- e r n <br />C—O, <br />e)6a? -- 1X53 <br />A. Signature <br />❑ Agent <br />X 7 \ ` } i t f: '' i ❑ Addres <br />B. Received by ( Printed Name) C. Wate o Delit <br />C <br />D. Is delivery address different from item 1 <br />If YES, enter delivery address below: ❑ No <br />3. S�ervI e Type <br />L1i-Cert ifled Mail <br />❑ ress Mail <br />❑ Registered <br />etum Receipt for Merchanc <br />❑ Insured Mail <br />C.O.D. <br />4. Restricted Delivery? (Extra Fee) <br />2. Article Number <br />(Transfer from service label) 91 7108 2133 3939 0 0 2 9 4 215 <br />❑ Yes <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02 -M -' <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 />Jt1V S <br />❑ Agent <br />'B. Received by ( Printed Name) C. Date of DelivE <br />/-'f�/ <br />D. Is delivery address different from Item 1? 11:7' <br />If YES, enter delivery address below: ❑ No <br />3. Sery <br />iVce Type <br />Certified Mail ❑ press Mail <br />13 Registered etum Receipt for Merchandi: <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number - <br />(Transfer from service label) 91 ?108 2133 3939 0 0 2 9 4208 <br />PS Form 3811, February 2004 Domestic Return Receipt 102595.02 -M-15 <br />