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F <br />• <br />4~ <br />E <br />V <br />~ComplaN NenM 1 anNa 2 for additional earvices. <br />~Complele items 3, aa, end fib. <br />rapdnt your name and address al the reverse o111Y5 form m that we can velum ItYa <br />card 10 you. <br />~Nlach this form to the hoot of the mailpNa, or on IM back i1 space dose not <br />pemvt. <br />aWdte'Aerum Receipt Requested'on the meilpiece below the ank:la number. <br />alhe Return Receipt r8a show to whom the adid. was tleGvwed and the date <br />delivered. <br />j~ <br />0 Br~jS S <br />~~^ <br />a <br />I also wish to rec&ve Me <br />fdbwing services (for en <br />extra fBB): <br />' <br />1. ^ Addressee <br />s Addres! <br />2. ^ Restricted Delivery <br />Consultposhnasterforiee. <br />e <br />i <br />s9~ 6Q3 <br />Ipe <br />i <br />^ Registered ~ L;ertified <br />A <br />^ Express Mail ~ ^ Insured w <br />^ Relum Recei ttor Merchandise ^ COD ° <br />7. Date of De ~aery ~ <br />~OSs~d ' <br />8. Addressee's ddress (Onl it requested ~ <br />and lee is paid) e <br />r <br />of s. Signature: (Addressee OrAger <br />r x ~~~ <br />Pe tom, 3871, War tee <br />tD <br />U]a <br />j <br />%c C. ~~ / <br />~ Z 19'1 5'9 & 6$3 ~~ <br />~1SPostalService -~~0 l: ~//-~}'j,~ <br />,Receipt for CertifiedlN~if- ~ <br />_. Na Insurance Coverage Provided. <br />Do no a for IntemaDonal Mail See reverse <br />o <br /> <br />Post , seta, 8 P Cad <br />lJ5 C~ <br />P S :>S <br />Certified Fee i 4 O <br />Spedd DBlivery Fee <br /> <br />Restntled (~ ~ A <br />y <br />~ <br />Return Receipt ro m <br />When 8 Derv vend ~ <br />Ntnm <br />Dale, 8 MAessee's O <br />TOTAL Postage 8 Fees 7' ZQ <br /> <br />Posronerk or Date W <br />W <br />S <br />N <br />((~~ <br />A <br />Jr`~ <br />