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v <br />oc <br />C <br />0 <br />C <br />i <br />t <br />P 436 784 316 ~`~~V. <br />US Postal Service <br />Receipt for Certified Mail ~ ~~ <br />No Insurance Coverage Provided. <br />Do not use for Intemalicnal Mail See reverse <br />Sent to <br />Street d Number <br />Po ,Slat , L / G <br />O <br />Posupe $ <br />Certified Fee <br />Spedal Delivery Fee <br />ReslnUed DeNVery Fee <br />', Relum Receipt Showi <br />d <br />' <br />Whom 8 Date Deliv ed ~ <br />Rehm Rseip ~ b m, <br />' <br />' r~ f ~ <br />1 <br />s <br />~ Dafe, 6 Mde,See <br />~ TO7AL Postage s <br />i I m <br />r Postmark or Dale ~ <br />~~~I C ' <br />~ <br />rJ <br />i 7 ~ a <br /> <br /> <br />"~3 <br />o- <br />0 <br />9 <br />e <br />a <br />0 <br />O <br />e <br />0 <br />•Complete ilerm 1 endor Z for additional aervicee. <br />•Cdnplete ilema 3, Ia, end Ib. <br />•Pdm your name and eddresa on the reverse of ihia form eo Met we can ratum Ittia <br />rard to you. <br />•Atlach Mia lone to tfr hoM of the meilpiem, w on IM beck it eDece do% not <br />permit. <br />•Wdle'Ra(um Receipt AepueaYed' m the meilpiers below Me ertiUe nurMar. <br />allq Relum Receipt will ahow to wlpm Ma aditla wee delivered end Me tlare <br />delivered. <br /> <br /> <br />a <br />E <br />94d.~9 <br />~~~~~~ <br />b. mgnai <br />T Y <br />w <br />PS Form <br />1 <br />3 <br />r <br />I also wish to receive fhe <br />following services (for a <br />extra fee): `~ <br /> <br />f. ^ Addressee's Address 8 <br />2. ^ Restricted Delivery y <br />Consult po <br />n <br />astef for <br />fee. <br />Str R <br /> <br /> ~ <br />p <br />/ <br />r <br />/ <br />(~ <br />tO r / a T 3 / ~i <br />, <br />rPe o <br /> <br />^-Registered ~Cerdfied ~ <br />^ F~cpress Mall ^ Insured c <br />^ Retum Receipt for Merchandise ^ COD ~ <br />(j~o C'i 7. Date of Delivery <br />b d ~. <br />B. Addressee's Address (Only it requested ~ <br />aAd lee Is pa/d) <br />1025959]8-01]9 <br />