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i <br />G.3r.4'I'le-8 Nla� 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. ArLJ6 Addressed to: <br />A. <br />❑ Agent <br />B. Receivepf by (Printe Name) C. Date of Delivery <br />a -3 v1 <br />D. Is delivery adOress different from item 1? ❑ Yes <br />If YES, enter delivery address below: 13 No <br />3. Se ice Type <br />q.Certified Mail ❑ Express Mail <br />0 Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) 13 Yes <br />2. Article Number 7012 3460 0000 6384 8314 <br />(transfer from service label) <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1 540 <br />'7- .. r• <br />M For delivery Information visit our website at www.usps.come <br />m <br />CD Postage: $0.48 <br />M Certified Fee: 3.30 <br />Return Receipt Fee: r cp .70 <br />a " 19'V14 <br />0 (End(Total Postage & Fee $6.48 <br />O -o' <br />Res( -- -,.., ..,.. ' � � <br />(Endorsement Required) T> r "r <br />l--3 <br />.0 <br />= Total Postage &Fees <br />M <br />ru Sent To ,p <br />r—1 - -- --------- - - - -'� !`J) C= --------- - - - - -- <br />------------------ <br />� Street, Apt. No.; J <br />or PO Box ��j <br />1711- -- --- - - -- __ <br />City, State, ZIP +4 - <br />'n <br />n <br />PS Form :00 August 2006_____ <br />