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" SENDER: <br />Complete sterna 1 end/or Z for etltlitionel aervieee. I 0150 Wieh t0 reC81Ve the <br />• Complete sterna 3. and ae 8 b. following services (for en extra Y <br />~ • Print your name entl edtlresa on the reverse of this form ep that we can fee): r <br />return this csrtl to you. j <br />~ • Attach tlue form to the Irons of the meilpiece, or on the beck if apace 1. ^ Addressee's Address N <br />r dose not permit. - <br />., <br />• Write"Return Receipt Regueated"on the meilpiece below the article number. 2. ^ RB9trlCted DBIIVery g <br />•+ • Tha Return Receipt will show to wham the article was deliveretl end the date <br />ei delivered. ~ Consult ostmaster }or fee. e <br />v 3. Article Addressed to: 4a. Article Number <br />B 80 73 ~(~~ <br />4b. Service Type <br />e MR HERMAN ROTHER ^ Registered ^ Inaured <br />R R 2, BOX 174 0 <br />OKARCHE OK 73762 <br />al 6. Signature IAgentl <br />_~ PS Form 11, Dec <br />~ertified ^ COD ,~ <br />^ Express Meil ^ Return Receipt for ~ <br />Merchandise <br />7. Date of Delivery ~ <br />~ -/~ -lrV3 ~ ' <br />8. Addressee's Address (Only if requested ~e <br />and fee is paid) a <br />t <br />t- <br />tr U.S,G.P.O.: tgg2-307-590 DOMESTIC RETURN <br />P 880 734 015 <br />Certified Mail Receipt <br />No Insurance Coverage Provided ~ <br />~• Do not use for International Mail O <br />~n•R (See Reverse) O <br />CJ <br />Q <br />n ~ <br />Q_l <br />0 <br />7 <br />7 <br />0 <br />m <br />en <br />ll <br />N <br />a. <br />mm <br />MR HERMAN ROTHER O <br />street a R R 2 , BOX 174 <br />OKARCHE OK 73762 <br />P.O., 9ute a ZIP Code <br /> <br /> <br />Postage <br />~' <br /> u: <br />Certifietl Fee r <br /> ~ F, :. CV <br />Spenal Delivery Fee i , n, <br />Vj <br />r C <br />C <br /> ¢ <br />Restricted Oelrvery Fee n <br />J V <br /> ~ <br />Return Recaipl Showing E <br />lp Whom 6 Dala pelwemtl ` <br />Return Receipt Shoring to Whom. _ <br />Dale, 8 Mtlress of Delivery <br />Tt7fAL Postage <br />8 Fees •~ T <br />Postmark or Data <br /> - <br />qp <br />U <br />d <br />C <br />N <br />0 <br />