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16 1, �/ �- <br />06h0 6922 2000 020E ETOL <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 />r Everist, Inc. <br />Box 5829 <br />%ioux Falls, SD 57117 <br />2. Article Number <br />(Transfer from service label) <br />PS Form 3811, February 2004 <br />A. "nature <br />Amq <br />❑ Agent <br />X � <br />❑ Addressee <br />a. Received by (Prnted a e) C. Date of Delivery <br />f <br />D. Is delivery ci farm from Item 1? <br />❑ Yes <br />If YES, enter delivery address below: <br />❑ No <br />3. Service Type <br />P6 Certified Mall ❑ Express Mall <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ yes <br />Domestic Return Receipt <br />102585-02 -M -1540 <br />