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o SENDER: <br />a •Colnplela items t anaor z for edditlonal services. <br />I also wish to receive the <br />r• •Completa items 3, da, and 4b. fdlOwing SBfVICBS (if.F an ' <br />m •Prlm your name antl addra•s on the reverse of this bnn so Nel we can return this g,rtr~7 fBBt: <br /> <br /> <br />~ <br />card to you. <br />•Adac' this form to the hoof or the mailpiece, or on the back i <br /> <br />t space does not , <br /> <br />1. ^ AddrBSSBB's AddfOSS <br />u <br />'~ <br />y • W'getum geceipl gequesred' on the meilpiece below Iha article number. 2. ^ RBStflCted DBIiVBry y <br />L, • Tha Return Receipt will show to whom the anitle was deliveretl end the date <br />delivered. <br />Consult posanaster for fee. <br />~ <br />o °1 <br />~ Ad <br />dr <br />essetl to: <br />3. <br />Ar <br />tic <br />le 4a. Article Number <br /> ' <br />~ <br />Q <br />~ <br />~ <br />~ <br />`, <br />"" <br />^"' <br />~ - <br />~ <br />E <br />y • <br />~ <br />" <br />1 <br />p ~ ~ X a~ ~ 4b. Service Type <br />^ Registered ~ Certified <br /> <br />W <br />~Q <br />io <br />C~41 ~ z~ ^ Express Mail ^ Insured <br /> <br />^ Return Receipt for Merchandise ^ COD 5 <br />0 , <br />~ 7. Date of Delivery p~ <br />- ~ - <br />i <br />z p . <br />7 5. Received By: (Pdnt Name) 8. Addressee's Address (Only i/requested ~ <br />w and /ee is paid) i <br /> .- <br />g <br />T 6. Signatu ~ ddrBSSeg orA ent) <br />y ~ l <br />/1 <br />/1 <br /> U <br />• <br />` <br />A <br />~ <br />- PS Rortn 3811, December tssa Domestic Return Receipt <br />