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Ce�i �iec� Mai'I - SO <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 />James Van Ella <br />180 Ln 200 Bass Lake <br />Angola, IN 46703 <br />A. Signature <br />i� edease. <br />❑ Agent <br />❑ Addressee <br />I�. eceived by (Printed N e)� C. Date of Delivery <br />i . ° 17i 1 2�t -1`14 <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service 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 />2. Article Number <br />(transfer from service label) 7012 3 4 6 0 0000 6 3 8 4 7959 <br />c PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -7540 <br />(Domestic Mail Only; No Insurance Coverage Provided) <br />For delivery information visit our website at www.usps.come <br />o Postage: <br />C3 ,Certified Fee: <br />c3 Return Receipt Fee: <br />0 <br />Total Postage & Fees: <br />M <br />$3 <br />$2. , FF8 <br />2014 <br />% <br />ru <br />a Street, Apt:ao.; James Van Ella ---- - - ---- <br />a °r PCE °X " °. 180 Ln 200 Bass Lake <br />City, State, ZlP +4 ---- - - - - -- <br />Angola, IN 46703 <br />