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•COmplete ilem9 1 fndw 21or edNtbr~al fervitef. 1 also wish t0 reCelVe the <br />•Complete Hems 3, 4a, and 4b. f01tOWing SBNiCBS ~fer an <br />•Pnnt your name antl edtlrees on the reverse of lhia tprm so that we can return tnia extra teb): <br />pro to you. <br />•Adach this tOnn to the traM of {ne mailpiece, or on the Eack it spate does nol 1. ~ Addre556e'S AddreSS ' <br />lgrmpl. <br />•W1ite'RMUm Receipt Requesfetl'on the maf{pece bebw the article number. Y <br />2. ^ RBStncted DBlivery to <br />•TM RMUm Receip will show to whom the snide was tleliveretl and ins date <br />dflivered. Consult postmaster for fee. <br /> Y <br />3. Article Addressed to: 4a. Arficle Number m <br />f1'~ f'vrl ~ n n <br />t C <br />l -7 /~~ 1 lJV ~.. <br />~~ <br />~ .Service Type S <br />1` C` <br />, (- <br />(U ^ <br />O <br />f <br />, ^ Registered ~\1 <br />rtified ~ <br />i„~ ,, n ~„ f <br />,.~ ^ Express r~'` ' ~etl <br />~ <br />`~~~f r ` ^ RetumR or MercharWise p C D °~ <br /> <br />~~~~ 7. Date of e I ' ry '~ <br /> t , ~~~ I r <br /> <br />5. eceived By: (Print Name) 8. Addrasse 's ddress (Only i(reque etl . ~- <br /> and !ee is psi A <br /> ~ ~ <br />r PS Fonn 3811, December <br /> <br />' Z 19 2 1 ~De9r Oar.~~ y~~y5~ <br />USPOStalService ~~~~ Vz <br />' , Receipt for Ce ) ie <br />' ~_ No Insurance Coverage Provided. <br />~: Dn not use for IntemadaW Mail (See reverse) <br />r <br /> el8 Nu <br />_ P , Stets, d ZI C ! ` ~I IS <br />W `-( <br /> Posage ,4 <br /> Certified Fea <br />%' Spedal Delivery Fea <br /> ~HmYnded Delivery Fee <br /> alum Receipt Styr ~ <br />rr~~ ~ , <br />-` m d Date Deli Ie~.` <br />.~ mRexplSMaipb Whxn, 'O <br />4 1)Me, 6 Maessees Ad~ess <br /> 7AL Postage 8 Fees <br /> adc or Data <br />J <br /> <br />i ,~4.,?5 <br /> <br /> ..~.~ ~ <br /> <br />