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^ Complete items 1, 2, and 3. Also complete <br />item 4 it Restricted 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 thfr}Q~a if space permits. <br />1. Article Addressed ta:, 1 <br />0,c1 Cl t"t 0. ~ ~ p <br />A. Signat^ ur~~ <br />X D Agent <br />^ Addressee <br />B. peceivetl by (Ponied Name) C. Date of Delivery <br />D. Is delivery address different from Rem 1? ^ Yes <br />If VES, enter delivery address below: ^ No <br />W ~ ~ ~ 3. SSe/rvice Type <br />(r{~f~/V(Qr p t ~t77el;ertifetl Mail ^ Fxpress Mail <br />l^Jy ^ Registered ^ Return Receipt for Merchandise <br />~' O S'Q 3 ^ Insured Mail ^ O.O.D. <br />4. Restricted Delivery? (Extra Fee) ^ yes <br />2. ArtideNUmber 7001 1140 0002 3883 7142- <br />(7ransfer from service label) <br />PS Forth 3$11, August 2001 Domestic Return Receipt to25gs-ot-M-25og <br />fv <br />r ~ . ~ ~,. <br /> <br />m poseage s 3 i <br />r:o <br />m <br />Certlfled Fee <br />~' ~ <br />~S~ <br />r <br />~ <br />D <br /> <br />C ~ <br />~ <br />Postmark <br />~y <br />\, <br /> <br />~, Return Receipt Fee <br /> <br />(Endorsemene Regairetl) <br /> <br />`~ P <br />Rere ~ ~ <br />~ <br />o <br />~ ` <br />i <br />~ <br /> <br />~ Reab7cted Delivery Fee <br />(Endorsement Required) _}_ <br />t <br /> y, <br />~ Total Postage 8 Fees $ 3.q a <br />~~ <br />'~ <br />~~ <br />S ~ <br />n <br />A ant o "'~ ' <br />~ ~ohn Nall <br />~ Street, Apf. No.; l <br />~ <br />~ p <br />wPO BOS NO. ~ l ' t <br />v`-'d~~0.t1 <br />O <br />~ <br />~ ~ <br />~a <br /> <br />M1 _ <br />arysraie,zm.a~ . <br />a <br />. <br />J~ <br />..mm~nYC"f_ (v _---_.__ <br />-.-._...-- <br />n QC1S"~'~ <br />