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<br />o SENDER: <br /> <br />v <br />•Gomplele items 1 ardor 2 for etltlidortal e9rvicea. I also wish to receive the <br />w .Complete items 3, 4a, end db. fOIIOWIng S6rVIC65 (for an <br />a • Prim your name erRd address on the reverse of this form w that we can return this extfa t66 <br />~ <br /> <br />j naN to you. <br />.Mach Ihia lortn to the horn of the mailpieca, or on tM betlc d apace dose not <br />ermit <br />1. ^ Addressee's Address ai <br /> <br />~~ <br /> <br />y p <br />. <br />•Wdte'Retum Receipt Requeated'on the rrtailpiece below the article rumba[ <br />2. ^ RBe[dCfed DBllVery . <br />y <br />~ .The Return Receipt will show to whom the article was de livered end the tla19 <br />e tleliverbe. Consult postmaster for fee, ° <br />~ 3. Article Addressed to: <br />/~ /~ 4a. Article Number <br />4a~ 33 ~ v ~~ m <br />E ,, <br />SCrnC(In CAGE W• ' <br /> , 4b. Service Type ~ <br />m <br />u ~• ~ ~ `UrGW e ~ ~ ^ Registered ~ Certified <br />m <br /> ^ Express Mail ^ Insured m <br />w n <br />~ <br />n <br />~ ^ Rehm Receipt for MlxdtanMse ^ COD ~ ' <br />c O <br />~ ~ <br />~[ ~ <br />1.. <br />/ Dat <br />li <br />7 <br />f ° ' <br /> l <br />y <br />V <br />O ve <br />. <br />e o <br />a <br />~ '~ Gl T' <br /> <br />' ~ 5. Received By: (Print Neme) 8. Addr ssee' Atldress (Only it requested ~ <br /> and lee is paid) L <br /> 6. Signature. ddressee orA nf) ~ <br />i. X~ <br />A <br />PS Fonn 811, December tssd . <br />-. ,E_: • _ ~; ~ . Domestic Return Receipt <br />P. 335 079 ® _ - <br />I~P~F ERTIFIFO MAIL <br />t S~G' NGE CA4EMGE PRON'~:e <br />~'~ OE FOR INEEflNAia1NAL MAIL ~ r <br />,, o........... ~ [J <br />~` ",__ .._. , <br />i Sam to <br />s2Vtecq l~ou~ CO. <br />a Street and No 1639 <br />o P O . 5 to antl ZIP Cotle ~/- ,/~ (1~ <br />~ <br />R' <br />~ <br /> ~ <br />~ <br />rwt.wr / <br />,A <br />~ <br />n Postage S <br /> - .~.~. <br /> Cen~l~ed Fee ~-` 4yn <br />'T <br /> Spec~pt Delivery Fee <br /> l <br />RestAcled Dslrvery ~ e <br /> Return`jieceipt showing <br /> <br />N to whom.antl Dat Delrve <br /> <br />~ ~d <br />Rewrn Receipt sho~'Iny t~ <br />, <br /> Date. antl Adtlr ry , <br />d <br />~ <br />TO7AL Postage antl Fees <br />5 <br /> <br />o Postmark or Date <br />m <br />E _ <br />o <br />LL <br />N <br />a <br /> <br />