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P 10"1 1 456 <br />oa ' rcy o <br />r Certified Mail ~ <br />y~• ce Coverage Provided. <br />wW ITn nn se tnr International Mail (See reverse) <br />Pgstage I S <br />Certified Fee <br />Speaal Delivery Fep = ~ ~ t . <br /> a <br />Restricted Deliver~Fea <br />Y 2 ~ 7•~y <br />m Return Receipl5ho 'ng to <br />~ Whom 8 Dale Delive d <br />_ <br />~q ReNm ReteptSMwrg to V9 ~g <br />a Dale,6AOdresseas Address <br />O TOTAL Postage 8 Fees a <br /> <br />~ Posanark or Data <br /> <br />0 <br />LL <br />N <br />a <br />d <br />v SENDER: <br />Complete items 1 anNOr 2 for additional services. I also wish to receive the <br />m •Complete ilema 3. 4a, end bb. following sBNiCOS (for an . <br />~ •Pnm your name antl atltlresa on the ravens of this form ao that we can return thin extra fee): <br /> card Io you. <br />•Anath This loan to the hanl of the mailpiece. or on the back i <br />f space does not <br />t, ^ AddreaSeB's AddrBSS O <br />u <br /> <br />`y permit. <br />• Wnte'Rerum Recaipr Requesled'on the mailpiece below the edicts number. <br />Q, ^ RBS1ffMBd DBIiVBry ~ <br />y <br /> •The Return Receipt will show to whom me adide was deliveretl and the tlate a <br />o aeliverea. Consult postmaster for fee. •d <br />c 3. Article Addressed to: 4a. Article Number w <br /> ~,, <br />, Q sa <br /> ~~ <br />, <br />,,,, <br />w <br />~ ~ 4b <br />Service T <br />e <br /> s <br />q yp <br />. d <br />v ~Q Q x CG I <br />L~ J I ^ Registered 6.Gertified <br />°i <br /> ^ Express Mail ^ Insured 5 <br /> ^ Return Receipt for Merchandise ^ COD ~ <br /> Deli ery <br />7. Dal <br />Z e <br />2 T <br />0 <br /> 5. Received By: (Pdnt Name) 6. Addressee's Ad ress ( my it requested ~ <br />w and /ee is paid) t <br />a 1- <br />g 6. Signatur : (Addressee orA eft) <br />i. X <br />N <br />PS Fo 3811, December tssa <br />Domestic Return Receipt <br />