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<br />^ Complete items 1, 2, and 3. Also complete <br />item 4 if Restdcted Delivery is desired. <br />^ Print your name and address on the reverse <br />so that we can return the card to you. <br />^ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressatl to: <br />Ms. Mary Jane Kleeman <br />Liberty Mutual Insurance Company <br />175 Berkeley $t. <br />Boston, MA 42117 <br />A. <br />X <br />by <br /> <br /> <br />• Z-z6-o7 <br />~~ <br />~~. ~~S <br />_~°~~y <br />D. Is delivery address different from item 17 U Yes <br />If YES, enter delivery address below: ^ No <br />3. S Ice Type <br />CeRified Mail ^ Express Mail <br />Registered ^ Return Receipt for Merohandise <br />^ Insured Mai! ^ C.O.D. <br />4. Restrictetl Delivery? (Extra Fee) ^ Yes <br />2. ARICIeNumber 7pp5 3110 OOQO 2197 9621 <br />(IYansfer from servke /abeQ <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 ; <br />J <br /> .~ <br />r-3 ~ ~ ~ <br />RJ <br />..D • . <br /> ,~~• <br />v!`- DR-lh~ ,~2r1Den03 <br />a <br />nJ Postage $ <br />0 <br />- <br />p <br />p cemnedFee ~ •. . <br />m Foatmarlt' <br />~ ipu ~ Here ' <br /> ired) <br />(Endorsement Rag ~ <br />~ <br />~ ResMdetl Delivery Fe9 <br />(ErWOrsemem gequued) <br />o - <br />m <br /> Total Postage & Feea ,~ <br />ul _ - _ .. _--_ - <br />o ro <br />~ Ms. Mary Jane Kleeman <br /> Sliee% qut 7~l0.; <br />Liberty Mutual Insurance ompany <br /> wPoeoxNa <br />.. <br />.. 175 Berkeley St. ______._____. <br /> ...... <br />.... <br />Oiy Sfem, ZIRH Boston, MA 02117 <br /> :,, <br />_ ~... <br />