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Z-416 876 916 <br />~ t for <br />G Ftfled-Me'iF---•- <br />~ 1D5ujpnce Coverage Provided <br />,rrG. D 5ib16se-ier"ie1~^~}~.Mail <br />ISee Reverse) <br />OHIO DIV OF REC1.ADtaTm <br />Sneer <br /> <br />io Wno - 6 Dme DeLVereO <br />eemm ce~oi Snowing io Wnom, <br />Ua~e, aka Addressee :padres <br />8 Fres <br />poSlma Oi Dale <br />Y <br />l <br />m SENDER: <br />9 •COrnplele dema 1 and/or 2 for additional services. I a150 Wl6h t0 reC91Ve the , <br />n •ComWale iferru s, aa, end aE. following services ifor an <br />0 U emB and addlBSa M 111a reveNB of this loan w Thal <br />•~ ~; OUI WB Lan re1Ym Ihl9 9xtfa 196 ~: <br /> <br />j L <br />•Aflaeh Itu6 form to the frprd of the meilgece, or on the Earle it apace does not <br />t, (] Addressee's Address ~ <br />°- <br />m <br />4 permit. <br />• Wrile'Relum Refbipr Requesletl' on the mailpiers below the adiGe number. <br />Z, ~ R931rICled D911Y91y Y <br />y <br />L •Tha Refum Receipt will show to whom the adige was deGvared antl the date <br />~ delivered. Consult postrnazter for tee. - n <br />0 <br />v 3. Artcle Addressed to: 4a. Artcle Number .~. w <br />d <br />a OHIO DIVISION OF RECLAMATION Z 416 876 916 E <br />E RESOURCES 4b. Service Type <br /> ATTN GREG RUSSELL ^ Registered ~ Certlfie'a <br />M <br />il <br /> FOUNTAIN SQUARE BLDG H-3 11307 a <br />^ Insured <br />^ Express <br /> COLUMflUS OH 43224 ^ RetumReceiptlorMercherrdise ^ COD <br /> 7. Data of Delivery <br />a <br /> <br /> 5. Receivetl By: (Pant Neme) 8. A ressee's Address (Onlyit regrresfed ~ <br /> ' and lee !s paldJ c <br /> t•- <br />g 6. Signature: (Addressee o e <br />a°. X <br />w <br />Ps Form 3811, December tss <br />Domestic Return Receipt <br />