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M- I9q 2 -X45 <br />Cer� -i.fic� Mai I - �0 lncompleie. <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 />Mr. James Van Ella <br />180 Ln 200 Bass Lake <br />Angola, IN 46703 <br />❑ Agent <br />B. eceived by ( Printed Name) I C. Date of <br />D. Is delivery address different from item 1? ❑ L1 Yes <br />No <br />If YES, enter delivery address below: <br />3. Service Type <br />❑ Ceruffed Mail ❑ Express Mail <br />❑ Registered 0 Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7012 3460 0000 6384 5375 <br />(Transfer from service label) - - <br />c PS Form 3811, February 2004 <br />Domestic Return Receipt 102595-02-M-1 540' <br />m Postage: $1.32 <br />-0 $3.10 <br />Certified Fee: $2.55 <br />o P Return Receipt Fee: <br />M (Endoi <br />C3 Restr Total Postage & Fees: ' " $6.97 <br />1-3 (Endor <br />—a <br />Total Postage & Fees <br />m <br />ru Sent To <br />'-q - Mr. James Van Ella <br />� Street, Apt. IVo. <br />orP °BoX" 180 Ln 200 Bass Lake --- ---- -- <br />--------- x No.- -- - - - - -- <br />C�ty, State, ZIP <br />Angola, IN 46703 <br />S. <br />Postal <br />Sery <br />ERTIFIED <br />TM <br />ECEIPT <br />L <br />omestic <br />Mail <br />Only; <br />No Insurance <br />Coverage Provided) <br />delivery <br />information <br />visit our v✓ebsite <br />at www.usps.come <br />r <br />m Postage: $1.32 <br />-0 $3.10 <br />Certified Fee: $2.55 <br />o P Return Receipt Fee: <br />M (Endoi <br />C3 Restr Total Postage & Fees: ' " $6.97 <br />1-3 (Endor <br />—a <br />Total Postage & Fees <br />m <br />ru Sent To <br />'-q - Mr. James Van Ella <br />� Street, Apt. IVo. <br />orP °BoX" 180 Ln 200 Bass Lake --- ---- -- <br />--------- x No.- -- - - - - -- <br />C�ty, State, ZIP <br />Angola, IN 46703 <br />