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N <br /> SENDER: Complete items 1,Z,3 and 4. <br /> m JY <br /> o Put your address in the"RETURN TO"space on the <br /> 3 reverse side. Failure to do this will prevent this card from P 612 676 148 <br /> 'W being returned to you.Thereturn receipt fee will Providers <br /> O you the name of the person delivered to and the date o1 RECEIPT FOR CERTIFIED MAIL <br /> delivery. For additional fees the following services are <br /> C available.Consult postmaster for fees and check box(es) i <br /> n NO INSURANCE COVERAGEPROVIDED <br /> to.,ervicsls!reges utetl, ' NOT FOR INTERNATIONAL <br /> MAIL <br /> t. Iff Show to whom,date and address of delivery. (� (See Reverse) <br /> 2. ❑ Restricted Delivery. <br /> t `G <br /> J. Article Addressed to: 'C Str t and f10. <br /> MA Ai� GoIo(;�,R���6n P. , tate and ZIP Code <br /> d ' '` <br /> euCt 54. "� C Postage S <br /> l 34 CC3 �I[[ is <br /> 4. Type of Service: Article Number A Certified Fee <br /> ❑ Registered ❑ Insured� Special Delivery Fes- <br /> CeNihed ❑LOD �IJL("•�Vl ���� - '+ <br /> LI Express Mail <br /> Q" Restricted DellveryFe9 <br /> Always obtain signature of addressee or agent and C Return Receipt Showing <br /> DATE DELIVERED. ' to whom and Date Delivered <br /> G 5. ig amra-Addr w Return recelpt showln <br /> D x rJ $ Date,and Address e ' SY <br /> 3 <br /> y b. Signature-Agent L) Ja TOTAL Postage eea <br /> �+ xin LL N <br /> O Postmark or D to <br /> In ]. Date of Deli " <br /> c <br /> ZR. Addressee's Address(ONLY if requested and fee p— e . <br /> U. <br /> v <br /> ti <br />