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/)'Ml <br />(" 1 19,13-s- 059 <br />Ce <br />r-t i �1'ed M CL i <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 />JCC C: <br />ACC)G°� <br />A. Signature <br />/t ❑ Agent <br />�1v ❑ Addressee <br />YB.�eceived by (PrinName) C. Date of Delivery <br />s <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />J. service Type <br />Cart fled Mall ❑ Express Mail <br />❑ Registered ❑ Retum 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) ?012 3460 0 0 0 0 6384 819 2 <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />Postal <br />CERTIFIED IVIAILT," RECEIPT <br />ru <br />Cr <br />(Domestic Mail Only; <br />Provided) <br />a <br />Cc <br />CD <br />M <br />Postage <br />$ <br />'- <br /><. <br />-D <br />48 <br />0 <br />Postage: <br />Fee: <br />�q� $2 <br />r3 <br />(Endor<ertified <br />Receipt Fee: <br />70 <br />C3 <br />Restri(Return <br />(Endors <br />� <br />Total Postage & Fees: <br />$6.48 <br />.:I- <br />Total <br />M <br />ni <br />Sent To �t j ��YL 1�A5 <br />C3 <br />C3 <br />- --------- ---- --- - - Street, Apt. No.; � <br />or PO Box No. � 0 �'-/ c5 <br />r` <br />- --- C lb <br />- ---- - ----- --- --- --- <br />City, State. ZlP +4 �y� � l CO � 2 /� � � <br />1 <br />-------------°----------------- <br />PS Form :0i 0r. <br />See Reverse for Instructions <br />