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l ;,3 <br /> q� s-z6 <br /> m SENDER: <br /> p •Complete items 1 and/or 2 for additional services. I also wish to receive the <br /> W -Complete items 3,4a,and 41d. following services(for an <br /> n a Prim your name and address on the reverse of this form ea that we can return this extra ise): <br /> rand to you. 4t <br /> Is <br /> Attach this torn to the horn of the mailpiece,or on the bad if space does not 1. ❑ Addressee's Address 3 <br /> e permit. V� <br /> p •Wrile'Retum Receipt Requested'on the mailpiece below the article number, 2, ❑ Restricted Delivery tR <br /> t. •The Return Receipt will show to whom the article was delivered and the date <br /> delivered. Consult postmaster for fee. a <br /> 0 <br /> v 3.Article Atldressed to: 4a.Article Number re3t L.0 Kc�Sobe 1 y I !0 4�a ��< <br /> E -��,�}} 4b.Service Type o <br /> 0 �f.IQ YIO ��-� Sr{ �7' ❑ Registered ❑ Certified <br /> m <br /> -1Roq W CK_ * 5 ❑ Express Mail ❑ Insured 5 <br /> n <br /> , ( [I Return Receipt for Merchandise ❑ COD <br /> L i o on,y,, �O ljvr��U�'I T.D�e ofSrive <br /> _ y 6 <br /> 5.Received By: (Print Name) 8.Addressee's Address(Only if requested <br /> and fee is paid) t <br /> F <br /> g 6.Signs e: (Addresse g fJ <br /> >, X <br /> A <br /> Ps Form 3811, December 1894 Domestic Return Receipt <br /> Z 4Wfgg2 481CLV <br /> Recelp,t for^ -gl1a3 <br /> Certified N�alf--- <br /> No Insurance Coverage Provided <br /> Do not use for International Maio <br /> (See Reverse) <br /> sem l0 1 Lr <br /> 6 C <br /> I:—] <br /> �7r03 P0 o ZIP Lotl Slate oner� Postage `0 �l <br /> F Cemhed Fee <br /> O fy <br /> ldG Soecal Delive,y Fee J <br /> IL 7� <br /> Hasmcted Ddl,o,Fee <br /> Hemet Peceior Snowmq L <br /> to Whom 8 Dale Deine,ed <br /> Relum Receipt Snow.ng io Whom ram, <br /> Dale,and Addressee's Address y <br /> 70TAL Postage J bb <br /> 8 Fees 9 <br /> Postmark o Date � t7\ � <br />