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m SENDER: <br />9 • ComWele hems rand/or 2 for atlWlional services. ^ <br />.y . Complete Uems 3, 9a, and 4b. <br />N • Pnnt your name and address on the reverse of this Corm so that we can return this <br />card to you <br />~ • Attach tNS loan tp the from of the mailpiece, or on the bacN it spaw does not <br />m Permit. <br />N • Wme 'Aelum Receipt Requesled'on the madpiece below the aNde number. <br />L • The Return Receipt will snow to whom the art¢le was debveretl antl Iha date <br />debvered. <br />0 3. Article dressed to:~~ . Arti le <br />a ;, <br />m <br />n ^ ~ 4b. Service <br />I also wish to receive the <br />following services (for an <br />extra fee)'. <br /> <br />1. ~ Addressee's Atltlress U <br />~ <br /> Z <br />2. ~ Restricted Delivery N <br /> <br />Consult postmaster for fee. n . <br />c 'Q 1 "'~"1"vr".~'~1 "p''~ ~G ^ Registerea <br />^ Express Mail <br />V ^ Rehm Receipt for Merchandise <br />~ ~ Q D ~ ~ ~ q 7. Date of Delivery <br />6-pD <br />5. Received By: (Print Name) 8. Addressee's Address (On!} <br />and lee is paid) <br />6. Signature: (Addressee or Agent) <br />;, X W r1xl~~p <br />~Cedified p~ <br />^ Insured O1 <br />c <br />^ COD ~ <br />T <br />`reques7ed Y <br />c <br />m <br />r <br />ti <br />"- Ps Form 3811, D€ceml,er fssa 1025959eB-0229 Domestic Retum Receipt <br />