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1 <br />1 <br /> <br /> Postage $ •r J¢ <br />] <br />1 CeniLeb Fee Lr ~Q <br /> Relurn Receipt Fee r <br />] (Entlprsemenl Requiretl) <br />7 <br />] ResviUetl DeLvery Fen <br />] (Endorsement Requretl) <br /> <br />] Total Postage 8 Fees ~ 'Z <br />I <br />J <br />~ Name (Please Prlnr Clearly) ( io be completed b) <br />' ...~Q...DwISroN DF...w!~~.~ <br /> Blreel, Apl No, or FO Bor No. <br />- P._o ,-- ~X... 3LI 5~..... .. <br />7 cay~r~TCZHfnegO(~T .5~-1NC~• <br />I <br />I <br />I <br /> <br />Posla9s <br /> <br />$ <br />1 <br />I Dendietl Fee <br /> Relurn Receipt Fee <br />1 (Enborsement Requiretl) <br />~ Restnctetl OeLVery Fee <br />1 (Enoorsemem Requiretl) _ <br /> <br />Total Postage 8 Fees A~ <br />LL <br />Y <br />1 <br />' learly) <br />se Prln <br />l C <br />lee <br />m <br />c <br />(P <br />Na <br />' J <br />n <br />` <br />'' <br />II <br />t~~ <br />l <br />~Cd <br />~Q <br />{V!'!N <br />4 <br /> . <br />.... <br />. <br />Btre~Gyt,~AQpf. No.: oryr PQO Bo+ <br />I V CJ_.... C/ U. <br />] CiIY le. ZIP+ ~m-T <br /> <br />'S .r <br />Form 811, July 1999 <br />8 <br />W ~~ <br />~. ~~~ <br />17 <br />Damesbc Relurn Receipt <br /> <br />P/ease Print Cleary) B. ate of 'very I • • r • • - <br />tM /as ! ti <br /> ul <br />/) ^ A <br />O r <br />gent <br />/ <br />'L' ~ F/ ~+~i,.' ^ Adtlressee 3, / <br />Posmgc s <br />` <br />' P ~ F ~ <br />~ <br />ess dflerent from item t7 ^Ves ~ • <br />f <br />slivery adtlress helow: ^ No ~ cen,l,~o Fee a-r (p ~y~d!` ~1 <br />ff O <br />PA <br /> ~, Relurn ReCeipl Fee ~j <br />IEntlrnsemem Requnetll 4 `~fl ~ <br />YI„o <br />~ - <br />N s ~ ~ <br /> ~ <br />~ Resbmtetl Delivery Fee S~ <br />O <br />dc <br /> p fEnborsemanl Regmwtl) L <br />g <br />rele~Jase Pnnf Clearly) I B. pa~ of D~eli~ p <br />V . _ .f~ ^7Agent <br />~1/~ ~---'~ ^ Adtlresser <br />tress tliHerent from M1em 1? ^ Yes <br />delivery address below: ^ No <br /> <br />ail ^ Express Mail <br />slurp REGEI \ for Merohandise <br />p ~ <br />~ <br />O Total Postage 8 Fees $ 3 : 1 <br /> <br />RllFFec_~lpienr's Name IPlease Pnn! Cleerly) (Ir be mmpl~led OV mine)) tail ^ Express Mdi <br />t,y~ 571gTE ~C`.(~_P~ ,L{1tNn WMN'~IS51oN ~S I Return Receipt for Merchand~s <br />~ <br />~~ ~~~~ --- ~~--~~- ~~~~ <br />- <br />it ^C.O.D. ~ Pio o PO Bn No <br />Sle i <br />Apt <br />all ^ C.O.D. <br />Ive vlExtra Fee I <br />ry~ ) ^ Yes 17 (7 <br />{313 S~~E.RMta rJ (l.(`ClY~ ~?'~ <br />..... _...... .... <br />.Irvery? (Extra Fee) ^ Yes <br /> <br />102595-99~M~1?89 pS Form 3811, JUIy 1999 Domestic Return Receipt t02595~99~M~1'!69 <br />.. =.w=tea mm~ ~ <br />~eturn Receipt for Memhantllse ~ N <br />^ C.O.D. T <br />rery? (Extra Fee) ^Ves • ~. <br />O <br />..~G-t .. I/V II M1 <br />102595-99-M-1]69 <br /> <br />ail ^ F,xGress Mail <br />Relurn Receipt for Merchantlls <br />II __..,O.C _D~D_, <br />t02595.99~M-I]BF <br />