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III IIIIIIIIIIIIIIII <br />sss <br />,~,~~, u.-,- cL.r <br />m SENDER: <br />4 • Complete items 1 end/or Z lar additipnsl aenicaa. <br />a Complete itama 3, end be b b. <br />~ • Print your name entl edtlreu on the reverse of this form ao that we can <br />i return this Gerd to you. <br />i • Attaeh this form to the front of the mellpi•ce, ar on the beck it space <br />does not Darmit. <br />t • Write"Return Racaipt gapueated"pn the mailpieca bebwtha article number <br />• The Return fleceipt will show to whom the article wee delivered and the date <br />C delivered. <br />~ 3. Article Addressed to: 4a. An <br />m <br />m SO VPtGYSC~ Y~`LVtlyy, l.Ot I <br />1 also wish to receive the <br />following services (for an extra <br />fee): <br />1. ^ Addressee's Address <br />2. ^ Restricted Delivery <br />3 4b. Service Type <br />p P,17, {~O~G s3S ^ Registered ^ Insured <br />y t ~ Q .$)y7J li ^ Certified ^ COD <br />S Urvt e ~5e 1 1 ~ ^ Express Meil ^ Mercha <br />~ ~ 7. Date of Delivery <br />~ 5. Signature (Addressee) 8. Addressee's Address (Only <br />h and fee is paid) <br />¢I 6. SigJfa,Yure IAgentl/~n i/ <br />Nod eyz <br />~ "~ P 1 7 9 $~~. 8 4 7 ~ r <br />Rece(p~f r ~`- <br />Certified ~-~~'02Z <br />O No Insurance Coverage Providetl <br />NO ~ Do not use }or International Mail <br />~ ISee Reversal <br />O <br />U <br />m <br />c <br />a~ <br />NC <br />C <br />F <br />sem ~o ~y ~tA <br />M+, Vasr ( Bewtr spyoe.sa~'co, <br />sneer d Np ~Dx S 3 <br />P 0 . Slale and ZIP Cotle <br />e~se}~ <br />8/43 L/ <br />Postage <br />Ce~blred Fee <br />speual Delaeiy Fee <br />Pesv¢Ie0 Delrverv Fee <br />aelmn gece~pi Snow <br />io Whom & Dade ~~ <br />nelmn Receipt' g to <br />Dare. and a e mess <br />r0int Ppsl ~ Zy <br />8 fees • - Si <br />Postmark or ~.~ O(4 <br />for <br />O <br />.Y <br />m <br />N <br />.4 <br />0 <br />O <br />fi <br />C <br />'w <br />7 <br />w <br />c <br />m <br />r <br />