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<br /> <br />~fr -c~~f ~L~ w <br />W <br />A~ t"`~O cC <br />-~~53 v' <br />- <br />7fice Slate. S ~P C ~ ' ~~~ ~ <br /> <br />Postage <br />Certified Fee <br /> <br /> <br />Spada) Derrvery Fee N <br />RrsOaded DeGveryf~§~,~~' .~ ~ <br />' Retum Receipt <br />'rtgN ~ ~ ~ <br />. <br />NRgm 8 Data red ~ ; ~ ~ <br />PesNe Receyt ~ WWlem, ~. < <br />Daro,dMdesree's ~ <br />TOTAL Postage d ,_ 'rte ~^ <br />PostrnaM or a ~ C <br /> <br /> <br /> N <br />~ <br />~ <br />p <br />G <br />~ <br />N C <br />a <br />r <br />_- -- - -- ' - - - - - -r- <br />o SENDER: <br />v • Complete items 1 and/or 2 for additional services. <br />I aISO Wish t0 lBCBlve the <br />'a1 •Complete items 3, 4a, end ab. f0110W1ng serVICBS (}Or 8n <br />m •Pdm your name and eddreas on the reverse at this form m Ihat we ran velum INa extra tae): <br /> <br />N .card to you. <br />•Mech thin form t0 the hom of the mailpiece, or an the bads if space dose not <br />t, ^ Addfess99'S Addles5 m <br /> •Wr e'Reram Aetvipf Requesled'on the mailpiece below the adicle number Q, 0 RBStdCted DBllVely y <br /> <br />~ •The RHYm Receipt will show to wTOm ma anitle wag deBvered end Iha data <br />aelivared. <br />Consult postmagter far fee. a <br />0 <br />~ <br />3. Article Addressed to: <br />~cr= ~~~ <br />c ~~a~ <br />n~ 4a. cle Number <br />~ ~ - 3 35 ~ (0.3 ~= e <br />i <br />. <br />o~u ~ <br />~ <br />~ ~ ~~ 4b. Service Type <br /> <br />ifi <br />^ R <br />i <br />d ^ C <br />d <br />d <br /> ~ stere <br />eg <br />ert <br />e a <br />rn <br />Q t~ <br />O <br />~ <br />a ^ Express Mail ^ Insured c <br />o U <br />/ <br />~O/Ild l ^ Retum Receipt for M andisa p COD <br />0 7. Date of Delivery <br /> 0 <br />T <br />~ 5. Received By: (Pant Name) 6. Addressee's Add (OMy it requested ~ <br />w and lee is paid) i <br /> F <br /> 6. Signs ur : (Add`e"ss~ rAge~ <br /> <br />n ~~ <br />- P 13 3 1 636 <br />a e <br />5~ ~~ o <br />' t for Certified Mail ~ <br />ra~+' ~ urance Coverage Provided. <br />E5" not use for Intemafional Mail See reverse ~ <br />~\ <br />Ps Porte 3811, December tssa Domestic Return Receipt <br />