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NI 21O- 033 <br />Cer- �� -�iec� Lec. Cc)n;orm0J-"0VL <br />/�C+i ve <br />SECTION SENDER: COMPLETE THIS SECTION COMPLETE THIS .. <br />• Complete items 1, 2, and 3. Also complete A. Signature <br />item 4 if Restricted Delivery is desired. ❑ Agent <br />X <br />• Print your name and address on the reverse ❑ Addressee <br />so that we can return the card to you. B. Receiv d by (Printed Name) C. Date of Delivery <br />■ Attach this card to the back of the mailpiece, <br />El on the front if space permits. <br />Article Addressed to: <br />Scott Waldenville <br />Bank Midwest. N.A. <br />P O Box 26368 <br />Kansas City, MO 64196 <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 <br />❑ Registered <br />r ❑ Insured Mail <br />❑ Express Mail <br />❑ Return Receipt for Merchandise <br />❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7012 3460 0000 6384 5399 <br />(transfer from service labeQ _ _ _ <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />Postal <br />CERTIFIED MAILTm RECEIPT <br />a- <br />0 <br />(Domestic mail Only, <br />Ln <br />7 <br />-r <br />Postage: <br />$0.46 <br />m <br />Certified Fee: <br />$3.10 <br />`0 <br />Return Receipt Fee: <br />$2.55 <br />E3 <br />O <br />(Ern Total Postage & Fees: <br />$6,11 1 <br />C7 <br />C3 <br />—0 <br />(Endorsement Required) <br />--:::j <br />_-- <br />Total Postage & Fees $ <br />M <br />rtt <br />Scott Waldenville <br />0 <br />Bank Midwest. N.A. <br />------------------------- <br />LSent-ro <br />P O Box 26368 <br />Kansas City, MO 64196 <br />„ .... bee F1Mff9rfo�rjnstructioffti__ <br />