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SENDER: <br />9 •Complete items 1 and/or 21ar etltliucrW services. <br />t also v+~sh to receive the <br />' <br />,~ •Complele items 3, da, antl 4b. following SBfVICOS (}Oran <br />m •Pdm you! name antl address on the reverse or this roan so that we cart return Ihi9 extra fee): <br /> <br />j card to you. <br />•Aaech Ihis form to the honl of the mailpiera, or on the beck it space does not <br />~, ^ Addressee's Addre55 ~ <br /> <br />y permit. <br />• Wdte'ReNm Receipt Requested'on the mailgece below the article number. <br />2. ^ Restdcted Delivery <br />y <br /> •The Relum Receipt will show to whom the ertiGe was deliveretl and the date <br />aeliverea. <br />Consult posbnaster for fee. <br />~ <br />o m <br />. to 3. Article Addr ssed to: 4a. Arficle Number ~-~/ d <br /> <br /> <br />° `` _` I/~~ ('~~ ~ ~ y-~ <br />~ 4b. Service Type <br />s <br />u t~ \_}J-~~J <br />' ^ Registered ~] Certified <br />W /~ 1~ ~.. 1 / 1 ~Q <br />lJ fix) ` ^ Express Mail ^ Insured S <br />a <br /> ~ <br />1 ~j/-~/ <br />"(~ <br />~(~ ~ <br />~~ ^ Return Receipt for Merchandise ^ COD <br />a ~ ~}- <br />1 ~ ( 7. Date of Deli/ve/ry <br /> <br /> 5. egeived By: (Print Name) <br />` 8. Addressee's Address (Only i/requested ~ <br />.W <br />~S and lee is paid) i <br />rc <br />~ <br />6. Sign e: ,yddre <br />see ar Agen ~ <br />0 <br />~T <br />~ PS F rtn 811, a ember fssa Domestic Return Receipt <br />rn <br />m <br />Q <br />Q <br />O <br />O <br />m <br />E <br />li <br />y <br />a <br />~' ~Z 3r30 086a~6~ ~~~7T~'~"~ <br />US Postal Service r~ , `pr ~ `~ a0 '~I.I S .t(~ <br />Receipt for Certified RRait---°-=g- <br />No Insurance Coverage Provided. <br />Do not use for Intemafional Mail See reverse <br />m ~ ~ e <br />V <br />m, Ike, <br />l <br />Posraga $ <br />Certified Fee ~~~~''F' S~'' <br />Spedal Delivery Fee ''~ <br />Reetdgea Delivery F IS° N 0 9 <br />Rehm Receipt Sh p Io <br />Whom 8 Data Relive <br />Ream Recepl ~*q m <br />Dah,8ld8aseei AtrYess <br />TDTAL Postage 8 Fees $ <br />PusMark or Dale <br />w <br />w <br />m <br />N <br />~7 <br />N <br />v <br />tL <br />C <br />CD <br />n <br />c? <br />N <br />