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<br /> <br />L <br />e <br />is <br />ILL <br />a <br />Z 416 942 6 4 <br />ReceiptP~O~ ~'~' <br />Certif~AA ~0~ ~ <br />No Insurance Coverage rovr e <br />~~ Do not use for International Mail <br />r rCee Gw~wrcwl P f <br />S w <br />C <br /> w <br />ne U. <br /> <br />P 5 ~ ~iP ~JA / ('d <br />~ ~(f <br /> <br />Posia e ~ ~ <br /> <br />Cerplied Fee .1 <br />Speoai Deeverv Fee - <br /> n <br />flesmcmd Deevery Fee ~ C <br /> <br />Pelurn P¢Ceip~ SM1Cwmg ~ • ~ .'>r~ ~ ,t <br />.c Whom 8 Dare Deirve~e - Q <br />PeWm Pece0t SM1pwing Ie Om, ; <br />Date, ano Addressee's Ad r ~ <br /> <br />TOTAL PoAage 5 ~'~. <br />& Fees <br />Postmark o. Date ~~ J ( <br /> <br /> I <br />1 <br />7 <br />7 <br />1 <br />1 <br />7 <br />>D <br />7 <br />V <br />J <br />o SENpER: <br />n •COmplBte items 1 anNOr 2 for adtlilional serNCee. I a150 WIStI t0 reC01V0 t/IB <br />o .Complete items s, ea, ane ab. fdlowing services (for an <br />• Print ypur name antl address on the reverse of this tone w that we tan return This extra f0e <br />rard to you. ~ o <br />Y •Ae~ this tone to the horn of the mallpiece, or on the balk it 6peca does net 7, ~ Addressees Addr0sS <br />` • Wdte'Rerum Necei r A uesfed' on the mail ace below the snide number. a <br />.The Return Receipt will show to wham the snide was deliveretl end the tlete 2. ~ Restricted Delivery y <br />ii tlelivared. Consult posbnaster for fee. u <br />E 3. Arocle Addressed to: 4a. Artlcle Number <br />~~ ~~ Gira~C~ / /~0 <br />a <br />a C ~~~~ t ~~~~-f 4b. Service Type <br />^ Registered Certified to <br />(J ^ Express M ' .~PSU,y Insured <br />a ~ ~G1y ,~, ~//_~~ ^ RetumFe pt e p COD .; <br />((P 7. Date of D liv s <br />= Y r r <br />5. Received By: (Pdnf Name) 8. Addresse r (Onl nested '>< <br />and !ee is p ~ <br />~i~4 ~L7~Su,*c./ B ~ <br />g 6. Signature: ddressee rAg nq <br />°>r X <br />m ~d--•..fl- 'Y~~ <br />Ps Form 3817, Dace a sa Domestic Return Receipt <br /> <br />