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• 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 />OV. RitC64Z.Er4' <br />, it <br />3031 IN • 22n•1 HSC <br />O,ev)v2r, Cc WOZLI-14Lo-49 <br />A. Signature <br />Agent <br />Addressee <br />B. Received by (Printed Name) <br />I C. Date -of Dmunerv, <br />D. Is delivery address differqW from fteW1 ? Yes <br />If YES, enter delivery SOWS below: 13 No <br />11� <br />3. Service Type <br />0 Certified Mail 0 Express Mail <br />0 Registered 0 Return Receipt for Merchandise <br />11 Insured Mail 0 C.O.D. <br />4. Restricted Delivery? (Extra Fee) 0 Yes <br />2. Article Number <br />(transfer from service label) 7010 1670 0000 8970 3850 <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 <br />U.S. Postal Service,,. <br />c3 <br />CERTIFIED MAIL,,., <br />RECEIPT <br />Ln <br />cc <br />(Domestic MailO nlY, No Insurance <br />Coverage Provided) <br />IT11 <br />lNg-TAr-M <br />E3 <br />1171- <br />F F <br />A L <br />Er <br />co <br />Postage <br />$ <br />C3 <br />Cerdfied Fee <br />C3 <br />C3 <br />Return Receipt Fee <br />C3 <br />(Endorsement Required) <br />r3 <br />Restricted Delivery Fee <br />(Endorsement Required) <br />Nh <br />rq <br />Total Postage & Fees <br />Qj <br />r3 <br />rq <br />nv <br />r-3 <br />-------------------------------------------- <br />---------- <br />Iti <br />Or PO Box No <br />-------------- I -------------------------------------------------City, State, ZlP+4 <br />----- <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 />OV. RitC64Z.Er4' <br />, it <br />3031 IN • 22n•1 HSC <br />O,ev)v2r, Cc WOZLI-14Lo-49 <br />A. Signature <br />Agent <br />Addressee <br />B. Received by (Printed Name) <br />I C. Date -of Dmunerv, <br />D. Is delivery address differqW from fteW1 ? Yes <br />If YES, enter delivery SOWS below: 13 No <br />11� <br />3. Service Type <br />0 Certified Mail 0 Express Mail <br />0 Registered 0 Return Receipt for Merchandise <br />11 Insured Mail 0 C.O.D. <br />4. Restricted Delivery? (Extra Fee) 0 Yes <br />2. Article Number <br />(transfer from service label) 7010 1670 0000 8970 3850 <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 <br />