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EXMrr R <br /> PROOF OF FILING WITH COUNTY CLERK AND RE ORDER <br /> P [12F 939 S70 <br /> Race pt for <br /> Cart' ied Mail <br /> No Insurance Coverage Provided <br /> Do not use for International Mail <br /> (See Reverse) <br /> Sam m \ <br /> I <br /> et and No <br /> sate an4 21P Code <br /> Postage $ J <br /> Candied Fee O <br /> Spacial Delivery Fee <br /> • Restricted Delivery Fee <br /> Return Rate*,Showing <br /> O1 to whom 6 Date Delivered <br /> i Retun Rep ,+om, <br /> C Date, antica <br /> D <br /> 1 TOTAL <br /> c; s Fee <br /> Q Post Date, 11II <br /> E 1995 <br /> s <br /> LL <br /> o SENDER: <br /> P 2 F I also wish to receive the <br /> as • Complete drams 7 sndlor or additional services. <br /> p • Complete items 3,and 4s a It. following services (for an extra V <br /> E • Print your name and address on the reverse of this form so that we can fee): Z <br /> e return this card to you. <br /> m • Attach this form to the front of the mailpiece,or on Me beck if specs 1. El Addressee's Address N . <br /> does not permit. <br /> y • Writs"Return Receipt Requested"an the meifpiece below the article number. 2. El Restricted Delivery 4 <br /> • The Return Receipt will show to whom the anicle was delivered and the date Y <br /> C delivered. Consult postmaster for fee. o <br /> 0 3. Article Addressed to: ^4s- Article Number <br /> oa"s C 3 50 <br /> E� 0 Service TypeRegistered ❑ Insure0 <br /> ( Certified ❑ CO <br /> Express Mail FrNt R t for <br /> ICO@ �VED <br /> `Q 7. Date of Delive J,N m e <br /> ` a <br /> cc <br /> T <br /> 5. Signature 1Addresseel 8. Addressee's dr ss if to lid Y ' <br /> M and fee is Pei c <br /> a <br /> cc 6. Signature (Agent (1 G <br /> t0PS Form 111, DbEfirrilber 1991 1ou.s.GPo:191ql-4Wa+4 DOMESTIC RETURN RECEIPT <br />