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MAC, P 2-0 13 - 019 <br />Cer�-i�Ie3 MGM I <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 />i�ue PAS Pk'v AE. <br />C 601,d`( <br />2. Article Number <br />(Transfer from service labeq <br />PS Form 3811, February 2004 <br />A. Signature' /ref( <br />A. r L s l r Agent <br />❑ Addressee <br />B. R ce'ved by (Printed Name) Q Date of Delivery <br />D. Is delivery address differen*P item 1? 'Q Yes <br />If YES, enter deliveryzoodress bbd: O -NO <br />3. Se Type <br />Certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />7011 3500 0002 9607 5257 <br />Domestic Return Receipt 102595 -02 -M -1540 <br />(Domestic Only; <br />ru <br />In <br />C3 <br />Postage: <br />$0.46 <br />-D <br />Certified Fee: <br />$3.10 <br />rr <br />Return Receipt Fee: <br />$2.55 <br />ti <br />O <br />(Ends Total Postage & Fees: <br />$6.11 <br />O <br />r3 <br />Rest <br />(Endorsement Required) <br />C3 <br />U7 <br />M <br />Total Postage & Fees <br />$ <br />r-=[ <br />Sent To l _ ` W `_ _' _ <br />E3 <br />r,— <br />Street, Apt. No.; <br />or PO Box No. I ((I � i W -- S V45 <br />° V Y <br />t� <br />T - �p <br />1 ---- T-`-'-`--- <br />City, State, ZIP +4 <br />di&, IP+ <br />Q C <br />PS Form :,, ,,. <br />----- -' <br />c � i9 See Reverse for Instructions <br />