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~~~A' I also wish to recei a fhe <br />•CemplMe items / and'W 21or edtlilienal aenricea. <br />w a~orrpNte ilema 3, Ea, and ab. follOWing sefViCBS Oran <br />•Prim yaw name and addreae on the reverse of tNS loin ao Nat wa can return Chia extra feb): <br />card to yau. <br />~ •Atlach dwe form to the horn of the mailpiece, or on the DaW if epaoa does nd 1. ~ Addr05see Address <br />~ patron. <br />~ •Wma'Relum Receipt Requested' on the rnalpieca 6Now Na enicle number Q, ~ Restricted ellVery <br />~ •TtN Return Receiq rill show to whom the anitle was delivered and the date <br />~ aNivarea. Consult posenaste for fee. <br />4 3. le Addre~~ : y ~O~ 4a. A 'cle N mbar ~ ~ C C <br />a / ~ <br />E n Q ~' /'f ~i 4b. Service Type l,It~-~ <br />u ~, f ~ ~~~ L'~ , 0.'.C,(l `~""~ ^ Registered certified ~~r <br />!'1 ~~ /„ ~ ^ Express Mail / -~ Insured !e <br />C/ ...((( ((( ,,, L1~ a <br />^ Return R ~^~ COD ~ <br />I ' '_~ C~ -~ 7. Date of I ~ <br />5. Re eived By: (Print N e) (3. Addres$ee Aq[J s (On ^ ~e nested <br />' ~~ and lee c <br />c 6. Si tur : (Rtldr S.49e or enf ^q-` <br />T X <br />= rs Form 3 77, Deambe ssa ~ omeslic alum <br />~~~ X70 <br />Z 13~ ~8b 63~_ <br />US Postal service ' 'r' ti ~ __~ <br />v <br />a <br />C< <br />a <br />r <br />d <br />c <br />t <br />Receipt for Certitiea man ~ <br />No Insurance Coverage Provided. <br />Do use for Int afional Mail See reverse <br />Sant ~ <br />Nu ~ <br />. <br />_. a, SIa,1p; 8 Zly a "7 ~ <br />G- ~ <br />~ <br /> <br />Postage S ~ <br /> <br />Certified Fee 3 <br />Spedal Delivery Fee y~\FL~~.ti~ ~. <br /> n <br />RaSNrted Delivery Fee ~" <br />Return rleoeiq Shorring <br />peGVered <br />Wlam b Date <br />d <br />F 1iA6we pacapl°--^bNtha. y <br />DaIRBpdrtessea'sedda~ 9 <br />~ TOTAL Postage 6 Fees s ~ ~ <br />~ PosnmarkdDane S <br />s ~ <br />i <br />~ <br />1 <br />7 <br />J <br />n <br />U <br />