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M/Ac' 4M- i%4 -oi3 <br />cer--�- ,'Fle-3 Mc+1, 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 />A. Signature 7 <br />Agent <br />X �R�l� i Z. �- ❑ Addressee <br />B Received by (Printed Name) C. Date of Delivery <br />W /K1����nt� <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />At, V1 t <br />tm) uc tq, <br />rV 4S1 C-0 T3. <br />OrCertified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mall ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7011 3500 0002 9607 5226 <br />(transfer from service label) <br />PS Form 3811, February 2004 Domestic Return Receipt 702595 -02•M -1540 <br />(Domestic Mail C <br />For delivery inform; <br />C`- <br />° <br />-0 $0.46 <br />°" Postage: $3.10 <br />ru Certified Fee: $2,55 <br />° Return Receipt Fee: <br />°O (Endo <br />a (End o Total Postage & Fees: $6.11 <br />° <br />lr) Total Postage & Fees I $ <br />M <br />Sent To <br />° Street, Apt. No.; <br />r kk <br />or PO Box No. <br />-----S-- tat-- e, ° Z- I -P +4 ---- -- -- -- <br />City, �� <br />