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<br />~ Certifietl Fee 3 V \ ?/, l3 ~ ~
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<br />~ Restdcletl De1Wery Fee
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<br />~ Totat Postage 8 Fees ey
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<br />~~----Q-(~---f....Minty~y---fin ~.-----~.;--~=----~=~._....-
<br />~-. Streeq Apt. No.; or PO Box No. (1
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<br />U.S. Postal Service>Ta i
<br />ERTIFIED MAILTM RECEIPT
<br />( omesfic Mail On/y; NOinsurance. Coverage Provided)
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<br /> M1 I Postage $ i"-~
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<br />Total Postage & Fees
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<br />Total Postage & Fees
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<br />$ 4• yy \
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<br />Ciry, SYafe, ZIP+4 - /y----T ." ..........................
<br />~~~\1 ~/-l ~~7i~
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<br />' CERTIFIED MAILTM RECEIPT
<br />(Domestic Mai! Only; No Insurence Coverage Prc
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<br />~ Postmark
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<br /> Total Postage 8 Fees $
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<br />Ciry, state, ZIP+4 __-
<br />_____________ _.-...._________.....-.
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