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i _;~ <br />r.. <br />Y4 SENDER: I also wish to receive the <br />M Complete items 1 and/or 21or atltlnional services. <br />e Complete hems ], and 4e R b. following services Ifor an extra <br />~ • Pnnl your name and address On the reverse of this /orm so that we can feel: <br />~ return this card to you. <br />• Attach this form to the front of the mailpiece, of on the back if space 1. ^ Addressee's Address <br />does not permit. <br />• Write "Return Receipt Requested" on the mailpiece below the article number. 2 ~ ReStriCted Delivery <br />• The Return Receipt will show to whom the article was delivered and the date <br />~ debvered. Consult postmaster for fee. <br />a 3. Article Addressed to: 4a. Article Number <br />s z y,6 <br />'"~ ~ "~ ' G~~ _ 4b. ' vice TYP <br />E ^ R stared <br />~~~-~ s,, <br />.` d Certified <br />~ ~ ~' ~ ~S ry ~ ~ ^ Express Mail <br />G ~-~ S~ ~ ' _ 1~ 7. ate of Deliv <br />a nnnn n L~O~ _ <br />R 5. Sy(q~ ature A dressee)( ~, ~{° ddte se 's <br />1~- \ \4lr { i ~ I ~~/~ c' r_.I;aAb f84 is pa <br />'U '1 <br />R 6. ture IAgept) ~~-~ ~ n~~~,~ _~C: j <br />^ Insured <br />^ COD <br />~ Return Receipt Tor <br /> <br />i <br />.. <br />V <br />E <br />OI <br />.Si <br />0 <br />C <br />r0 <br />N <br />r <br />sYU.S. GPO: tYGS~-352-71s DON-ESTIC RETURN RECEIPT <br />