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Cc- 1'e d MuSENDER: COMPLETE THIS SECTION COMPLETE THIS j I <br /> DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. $ �_ Agent <br /> ■ Print your name and address on the reverse X '� ddressee <br /> so that we can return the card to you. B. Received by(P a e) �, C. Delivery <br /> ■ Attach this card to the back of the mailpiece, I I r <br /> or on the front if space permits. <br /> D. Is delivery address er t from 1? Y s <br /> 1. Article Addressed to: If YES,enter delive dd s b dA o <br /> 3. Seroee Type <br /> Certified Mail ❑Express Mail <br /> ❑Registered ❑Return Receipt for Merchandise <br /> ❑Insured Mail ❑C.O.D. <br /> 4. Restricted Delivery?(Extra Faat ❑Yes <br /> 2. Article Number 7p11 3500 00172 9607 6049 <br /> (Transfer from service labeq <br /> PS Form 3811,Fg*wiy 2004 Domestic Return Receipt 102595-02-M-1540 <br /> Postal <br /> (DomesticCERTIFIED MAILT. RECEIPT <br /> Postage: <br /> _.._-_ <br /> o Certified Fee: $0.69 <br /> Er Return Receipt Fee: $3.30 <br /> $2.70 <br /> ru <br /> ED RetTotal Postage& Fees: $6.69 <br /> (Endors( <br /> E3 v/ <br /> Restricted Delivery Fee <br /> C3 (Endorsement Required) U F, <br /> C3 <br /> ul Total Postage&Fees <br /> m <br /> Sent To <br /> Stieet,Apt No.; <br /> �. or PO Box No. <br /> �.a. �s1 <br /> ------------------------------ <br /> City State,ZIP+4 /n <br />