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SENDER: <br />• Complme hems t andlor z Tor add'nlonal services. I also wish to +eceive the <br />•> • Complete items 3, end 4a b b. follO Wing SerVICCS (tor an extrd V <br />~ • Print your name and address on the reverse of this form sa that we can fee): '~ <br />'~ return this wrd to you. <br />~ • Attach this loan to the front of the meilpiaca, or on the back it space <br />t. ^ Addressee's AddreSS <br />m <br />y <br />., dam not permit. <br />0 • write"Return Peceipt Pequested"on the mailpiace below the article number. <br />t <br />2. ^ Restricted Delivery G <br />•m <br />.+ • The Feturn fleceipt will show to whom the article was daliv/ad endthe date ~ <br />e delivered. Consult o5tma5ter for tee. o <br />° 3. Article Addressed to: <br />7 4a. Article Number ~ <br /> // e <br />~00 ~Q <br />a I <br />~ <br />~ (J <br />mil m <br />, <br />q <br />C c <br />/ 4b. Service Type <br />0 8 <br />~ D <br />~ <br />~x 5[ ^ Regiljered ^ Insured <br />N ' <br />` ~Cerlified ~ COD <br />uNi r -/- ~'p G !~ ~ <br />O ~ 3 <br />ONI C'/IL'[ ^ Express Mail ^ Return Receipt for <br />h <br />di <br />M ~ <br />C / erc <br />an <br />se o <br />~ 7. D e of Delivery •. <br />a <br />_ _ <br /> 5. Signature IAddresseel 8. Addressee's Address IOnly if requested x <br />F and fee is paidl ~ <br /> <br /> 6. $ignat (Agent) i//J/ ~' <br />~ ~ ~~`~lGiai -' ~ <br />P Form 11, December 199i ,r t,.s.o.P.o.: t5az-3pT-sao DOMESTIC RETURN RECEIPT <br />