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Postal <br /> MAIL'CERTIFIED RECEIPT <br /> 43 Domestic Mail Only <br /> O <br /> O , 1 � I C a ; <br /> m $ Postage: $0.460 <br /> nj Certified Fee: $3.350 <br /> o t Return Receipt Fee: $2.750� <br /> C3 t <br /> C3 t <br /> I Total Postage and Fees: $6.5 ?S� <br /> p Pw y <br /> :I- $ OJI <br /> A Total Postage andru <br /> Fees <br /> $ <br /> .17 Sent To <br /> rq <br /> E3 Se-a--dA p-t NOO.,ob -o-. le <br /> -- <br /> ------------------ <br /> City,State,20;4• <br /> • <br /> COMPLETE • SECTIONETE THIS ON DELIVERY <br /> Signature <br /> ■ Complete items 1,2,and 3. A. ❑Agent <br /> ■ Print your name and address on the reverse X ❑Addressee <br /> so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. Cz `' <br /> D. Is delive s differen'fitem 1? ❑Yes <br /> If YES ter delivery address tfO� ❑ No <br /> t �a <br /> Liberty Mutual Insurance Company <br /> 175 Berkeley Street <br /> Boston,MA 02116 - 3, Service Type C Priority Mail ExpressiV <br /> 11111111111 I IIII III I II I IIIII I II III II I I I II I IIII III ❑AAdultdult Signature 0 Registered Mali� <br /> Signature RR2.Q. PO ❑Reg Registered Mail' <br /> iRestrioted <br /> ❑Certified Mail® Delivery <br /> 9590 9402 2053 6132 7804 63 ❑Certified Mail Restricted Delivery ❑Return Receipt for <br /> rl Collect on Delivery Merchandise <br /> C Collect on Delivery Restricted Delivery [ISignatuto Confirmat,111TIA <br /> 2. Article Number(Transfer from service label) —Insured Mail ElSignature confirmation <br /> Insured Mail Restricted Delivery Restricted Delivery <br /> 7016 2140 0000 2346 0608 (over$5oo) <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br />