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~ SENDER: I also wtsn to receive the <br /> <br />» . Crnrrylete lternet and/or2ror additbrw a.mce. <br />• Complete dame 3, 4e, wM 4b. followin services loran <br />g <br /> • Pnnt your name erM atltlress on the reveres o1 ede brm w that we can return mie <br />rem to you. <br />• Aaach aria torte to the hoot Ot ere rrWlpiecs, or on dra beck M apace dose nq extra fee): <br /> <br />7. ^ Addressee's Address <br />Q <br /> pertnd. <br />• W nw 'Rebm Race/pf Requested'on Me meilplaca below the artlcte number. <br />2. ~ Ra6fiCled Delivery <br />e • dThe~~m Receipt wet show to wlpm Ne arorJe was tlelivaretl entl dw den (v`Orl3ull pOStm85fef }Of }BB. _ry <br />0 3. Article Addressed to: 4a. Article N umber <br />~ Z 43 9 I St7 <br />s Jerald Se i ~ e rt' 4b. Service Type e <br /> <br />O• WX 3Drj <br />P ^ Registered ~.Cerdlled <br /> , ^Express Mail plnsured ~ <br /> W e stc I ; ~~'e , ~ ^ Return Receipt for Mercnendise ^ COD ~ <br /> 8• a sa ~~ Date of Delivery E <br /> dsr ~, <br /> 5. Received ey: (Pont Name) B. Addressee' d ,(Orr ested '~ <br /> <br />r <br />and lee is <br />id '~" <br />Uti m c <br />e <br /> 6. Signatur r ee or Agent t <br />'O b - N <br />~ F <br />r ' <br />'o X e ~i~~ ,~ <br />~ <br />s PS Ponn 3811, ember t ,az~as~sa~ Do `Re , Receipt <br /> <br />_ Spey. <br />Z 4 3 4, 9 4 ]Fj)~ L.7 ~14~ ,,,_ <br />US Postal Service 7~ OD` j <br />Receipt for Certified Mat <br />No Insurance Coverage Provided. <br />Do not use for International Mail See reverse ~ <br />°v <br />CQ <br />a <br />K <br />ti <br />6 <br />Sint to <br />J i e <br /> <br />Street E Number ~ <br />? <br />~ C <br />Post Office, Slate, d ZIP Cade Q ~ i Qr (-0 4 <br />.0• $I <br />Postage S <br />Certified Fee <br />Spedal Delivery Fee <br />Restricted Delivery Fea <br />Return Receipt vsYj '1 ` = <br />whom d Dale 'v <br />Realm gacagrSyw/rg toWMm, ~~~• <br />~ <br />Dale, 6 Adtlrtssee§ Address ~ <br /> <br />TOTAL Pos18~ d Fees% <br />i t <br />$ )' <br />Posbnerk Sir Dbte - / ` J r <br />, <br />~~ <br />/ <br />' <br />\\ <br />a. ~ , <br />\ <br /> <br />