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P 213 351 675 <br />us \5 ~ ~ <br />~te o Mail <br />5 b I e royided. fi7 <br />Doe or tnmatinnal Mna Lcoo .a~.a.cai <br />F <br />m <br />m <br />Q <br />C <br />O <br />li <br />a <br />to c ae <br />e ca 1 o w <br />b"`~- <br />~ <br />awer <br />P Office, te, 8 ZIP~gde ~' ~~ ~ <br />~ (~ ~D <br />Postage a ~ <br />Car7fied Fee ~ <br /> <br /> <br />Spedal Delivery Fee IV <br /> <br />Resbided DaAVary Fee .1 <br />~ <br />Retum Receipt Showing to ~ <br />Whom B~Dale Del d _ <br />- _ <br />Realm R <br />Shh <br />.vag <br />N'ham <br />Y <br />~~ <br />Dale,B~ CAD <br />TO7AL Pasteye 8 Fees $ n <br />PosMark or Dale O <br /> <br /> <br /> 0 <br /> w <br /> •COmplele'~Lems 1 ardor 2 for additional aarvicea. <br />•Complete items 3, ae, and 4b. 19150 Wlsh t0 rBCeiVB the <br />IOIIOWing SBfVIC85 (}Oren <br /> .Prim your name and address on the reverse of this farm so that we can velum This <br />- Bxtre fee <br />~ <br />d <br /> <br />j card to you. <br />•Adech~ nie form to the honl of the mailpieca, or on the bark if space does not <br />t, ^ AddrB55ee'a Address I <br />' <br />~ <br />Z <br />~ <br />y pemut. <br />• Wdte'Rotum Receipt Requested'on the mailpiece below the anicle number. p. ^ Restricted DBlivery y <br />ra •ThB Retum Receipt will show to whom the snide was deliveretl end the dale <br />delivered. <br />Consult postrnaster for fee. C <br />~ <br />° <br />0 ~ <br /> ~I <br />dldressed to: I ~ <br />3.,Anrti~cle A <br />' <br />f aappicl~Nim~ber ~~ I ~~~ <br />' l <br />J <br />. <br />J c <br />a a~ <br />~ <br />~, <br />4'I G^'Pi l <br />A- <br />l. <br />V VU.( r <br />o <br /> <br /> <br />° ~ <br /> <br />()~ ~ <br />~~ <br />' 4b. <br />S <br />ervi <br />e <br />T <br />e <br />isteredp ^ Certified <br />^ Re <br />tv <br />~ <br /> ~ <br />L.Q~~, <br />et g <br />^ Express Mail ^ Insured <br /> <br />~~ ~~ f m <br />° <br /> ^ Retum Receipt for Merchandise ^ COD <br />0 <br />~ <br />~ C~ ~3 7. Date of Delive <br />~13 9 <br />~ <br /> a t ~ . <br />~ 5. Recei d By: (P 'nt Name) 8. Addressee's Address my it requested ~ <br />w and lee is paid) i <br /> <br />~ 6. Signature: ( dresses Agent) <br />~• <br />A X <br /> PS Form 3 1, December tssa Domestic Return Receipt <br />