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M / "— <br />M- IC190 -opt I <br />Cerhfi_eel Mai I <br />• Complete itenrs.l, 2, and 3. Also complete <br />4 item 4 j ribted 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 />/I1�Ir, V�e�J e �. <br />A. Signature <br />X <br />Agent <br />B Received by (Printed Name) C. Date f Delivery <br />_7;n A-(JVV�;u)C•C �_ I�1f"t(13 <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Se Type <br />Eff Ctrtifled Mail 13 Express Mail <br />❑ R401stered ❑ Return Receipt for Merchandise <br />❑ Irdured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7011 3500 0002 9607 5219 <br />(rransfer from service label) <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />(Domestic Mail C <br />J For delivery inform <br />,11 Postage: <br />$0.46 <br />117 Certified Fee: <br />$3.10 <br />ru Return Receipt Fee: <br />$2.55 <br />C3 Retum <br />C3 (Endomemf <br />C3 Total Postage & Fees: <br />$6.11 <br />Restricted <br />M (Endorsemi <br />O <br />tJ7 Total Postage &Fees <br />$ <br />M <br />Sent To <br />e -- <br />a- <br />-- - - - -V ----------------------------- <br />a <br />Street, Apt. <br />or PO Box No. �` 3- G R - l <br />------------------------- --------------------------------------------------- <br />C�ty State, ZIP +4 r& & GO <br />do ^QC ' <br />PS Form :,, August 2006 <br />instructions <br />