Laserfiche WebLink
co <br />N <br />0 <br />U <br />C <br />Q <br />Sri <br />N <br />(~ <br />~~._N <br />~~ <br />~= <br />~/}S <br />db <br /> <br />~.~~0" <br />y <br />'T1 <br />p 436 7,85 328 0 <br />US Postal Service ,~ <br />Receipt for Certified Maill ~ <br />No Insurance Coverage Provided. ,~ <br />Do not use for Intemalinnal Mail /See re arse) <br />~•~ <br />Streai 6 Nl~rl r 5 <br />'~ / ~ <br />P t Ofrim, le, d ZI ode <br />vee <br />80G. <br />Postage $ .~ <br />Certifi ~ p~ <br />alive <br />ed Deli~ry Fea <br />R m ovn IBu <br />Wh 8 ~` _ 2S <br />Revm >! N <br />Date,BAddr s <br />TDTAL Postage 8 Fees $ d- <br />Posbnark orDale <br /> TENDER: I also wish to receive the <br /> . Complete items f anNOr 2 )or adalional serves. <br />, Complete ,lems 3, 4a, and 4b <br />following services (for an <br /> , Print your name antl atltlress on the reverse of Ihis IOrm so Thal we can return mis extra fee): <br /> cartl to you. <br />• Attach Ihis form to In0lront of the mailpieca, or on the back it space does not <br />1. ^ d„idressee's Address <br /> permit. <br />• Write "Return Receipt Requesled'on the mailpiece below the a <br />rticle number <br />2. ^ Restricted Delivery <br /> .The Return Receipt will show to whom Ine article was delwered <br />delrveretl. antl the tlale COnsUll osrmaster for Tee. <br />P <br /> <br />`? 3/A~nicle Ald~dressed fo: <br />~ Q <br />~~ 4a. icle N ~m1b r ~i[ <br />~J~ ~UL <br />1J <br />~ <br /> ~IM n11 <br />n r. <br />i ~ . <br />t <br />n 4b. Service Type <br /> <br />~ <br />E <br />~~.Q... <br />~" T 1 <br />^ ed Certified <br /> <br />3 ~ ~~ r~ ~ ^ Insured <br />Return fie ~ r Merchandise ^ COD <br /> .Date of Delivery <br /> ., F~ t o 2c.:~ <br />5. Received By. (Print Name) <br />f <br />6. Signature: (Addressee rAgenf ~ - <br />~ X <br />~r _.-.~ <br />ai <br />Z <br />N <br /> <br />v <br />Ix <br />m <br />c <br />N <br />O <br />0 <br />Y <br />C <br />R <br />L <br />r <br />'S Form 3811, December t~ 102595-98-84229 Domestic <br />