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~. <br />~ SENDER: <br />y • Complete hems 1 an0/or 2 for adOrtional services. <br />y • Complete Hems 3, end 4a & b. <br />~ • Print Your name antl address on th¢ reverse of this form so that wa can <br />~ return this cab to You. <br />y Atlath this loan to the front of the mailpiece, or on the Dack d Space <br />~ does not permit. <br />L • W me "Return Receipt Requestetl" on the mailpiece below the article numbs <br />• The Return~eceipt w~Il show [o whom (he anicl¢ waS d¢livered antl the dat <br />G tlelrvered. ' <br />m 3. Article Addressed lo: 4a~Ai <br />E Mr. J rsm K~~r 4b. st <br />I also wish to receive the <br />following services (for an extra <br />feel: <br />1. ^ Addressee's Address <br />2. ^ Restricted Delivery <br />~ Cp~DW?r0 C ~R 1 ` ~~ ~ l ' ^ Registered <br /> <br />yy 7 // r ~ <br />~ QY <br />~ <br />` 3/ <br />~~ <br />~j ~Certitied <br />u <br />i / ^ Express Mail <br /> r <br />' <br />/ /,J <br />p <br />0 ~ <br />~ <br />!"rye" p~ ~`~ O 1 O "1 ~ of D liver <br />7. Dace <br />~ Q <br />p <br />~ 5 . Signature (Addressee) 8. Addr ssee's d <br />~ and tee is paid) <br />^ Insured <br />^ COD <br />~ Return Receipt for <br />F- <br />~ 6. na IA t)1 <br />NPs Form 11, ts9t aU.s.GPO:raB2~3Wa DOMESTIC RETURN RECEIPT <br />D~ <br />U '~ <br />~ '. <br />d <br />H <br />6. <br />ml <br />UI <br />d <br />G <br />~~ <br />~~ <br />rni <br />NI <br />O, <br />~~ <br />et <br />m <br />L <br />I- <br />