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�M� ��12Ui0 -U�SU <br />ce',- 1 ed ma-1 <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 <br />X n' , <br />❑ Agent <br />❑ Addressee <br />B. 7ed t?y Printed Name) C. Date of Delivery <br />D. Is delivery ad ress 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 />.ber 7011 3500 0002 9607 6650 <br />service /abeq -- <br />ibruary 2004 Domestic Return Receipt 102595- 02 -M -1E <br />(Domestic Mail C <br />' For delivery inform, <br />C3 <br />� <br />Postage: <br />$0.48 <br />Certified Fee: <br />$3.30 <br />c3 <br />��__ <br />Return Receipt Feey4, ,-,'30 ,9o,` $2.70 'lark <br />O <br />C3 <br />a e <br />Postage & 64s: 6.48 <br />C) <br />(Total <br />Ln <br />Total Postage & Fees <br />M <br />Sent To -- <br />w d <br />C:3 <br />----------------------------------- -------------- <br />Street, Apf No.; C 1 <br />orPO Box No 1`7 C, <br />---- --- ----------------------------------------- <br />------------ --- <br />City, State, ZIP +4 <br />L�AWd , CO g)oc; <br />a- <br />