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l~v-o o ~ o ~ Cer~1. ~~ <br />~ r I~,r v,o (~.7~i o~.~. <br /> <br />^ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />^ Print your name and address on the reverse <br />so that we can return the card to you. <br />^ Attach this card to the back of the mailpiece, <br />a on the front if space permits. /~ <br />1. Art~eAd~is) I ~ ~ 1 ~"'t~~~ <br />2~ .~-v.r~- ~ S'h^ l a~ f 6c Y.~ ~ <br />~-,( jam' ~ ~/~ ~.~ . <br />~ .30/2/ <br />A. Sign tt e ~ ((1) <br />X ~ e I- I / ~"T/'/,O Agent <br />~l~ `'""^ Addressee <br />B. f~ece~ved by f~Pnnted NarpeJ t C. Date of Delivery <br />D. Is tlelivery address drfferent fiom item 19 /U Yes ' <br />/~ i~ ~ <br />If YES, enter delivery adtlress below: ^ No <br />> ~ ~I, <br />~~ j `- <br />3. Service Type ~ -- " <br />^ Certified Mail ^ Express Mail <br />^ Registered ^ Retum Receipt for Memhandise <br />^ Insured Mail ^ C.O.D. <br />4. Restricted Deliven/1(Extra Fee) ^ yes <br />'2. Article Number <br />tlransfeNromseMCelabe <br />7003 1680 0000 6431 3811 <br />PS Form 3$11, February 201M Domestic Return Receipt 102595-02-M-1540 <br />,~. ~~ _ ~_ <br /> ~~ <br />rR ~ r <br />~ I• <br /> <br />m t~3 ~egn~suq~ <br /> <br />s <br />`0 <br />Postage: $ .39- <br />~ <br />o Certified Fee: , x$2.40 ~`~ <br />o <br />o ~„d;~ Retum Receipt Fee: $1.85=~ c\ <br />pew ' ~S%~ JAN ~'-~~ , <br />~ ~'"°r Total Postage & Fees~$4 <br />64~~~ ~~ <br />a . <br />total Rmlaee a r-eea $ <br />s <br />~ <br />m ~ <br /> o • , <br />~A. 4,I~t~. ~ <br />-. <br />- <br />~ arPo9axN ZZq.L NLtGrSTI"/'~' <br />-/.-/'/(!~ /CJl. <br />