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• • S <br />+I <br />o SENDER: <br />V •Complala items 1 anNOr 2 for atltlttiorW services. I also wish to receive the ' <br />re •COmplete items 3. 4a, and 4b. ~ ~ fOIOWIng eervICBS (}Or an <br />N • Print your name and atldress on the reverse of this form so that we can return tNS 0x[2 fee): <br />l <br />j card to you. <br />•Adach this brm to the front of the mailpiece, or on the back if spars does not 7, ^ Addressee's Address s <br />Z <br />~ <br />o pennil. <br />•Wdte'Refum Receipt Requesfed'on the rnailpiece below Neanicle number. p,^Restricled Delivary y <br /> •The Return Receipt will Show to whom the anitle was delivered antl the data <br />deliveretl <br />Consult posbnaster for fee. <br />°~ <br />~ . $ <br />o <br />a <br />d 3. rficle Addressed to: <br />Gt ol <br />~ ~nrt~a~ <br />a 4a. 'c u <br />3~~ <br />~. <br /> . <br />. . <br /> <br /> <br />l <br />~L <br />~ O ~Q~ 4b. Service Type <br />u <br />v . <br />. <br />~n 0 ~ G n <br />$ `~ J~ ^ Registered ^ Certified <br />ress Mail ~^ Vnsured <br />^ Ex <br />~ <br />w <br /> <br />~ w p <br />^ Return Receipt for Merchantfise ^ COD N <br /> 7. Date of Delivery 3 <br /> 0 <br />T <br />~ 5. Received By: (Print Name) 8. Addressee's Address (Only it requested ~ <br />w and /ee is paid) i <br />Q I- <br />g 6. Signatur ~ (Address orAg <br />0 <br />~. <br />X ~ <br /> <br />~ PS Fo 8 1, ecember 1994 Domestic Return Receipt ; <br /> r - - - - <br />.~a~ <br /> ~.. <br />W7 <br /> 025 <br />~ <br /> i ~ R CERTIFIED MAIL I <br />rJ~' <br />INSDRANCE COVERAGE PR <br />~~` <br />i <br />0 <br />v <br />N <br /> <br />d <br />0 <br />E <br />`o <br />LL <br />N <br />a <br />A OVIDED <br />iF NOT FOfl INiERNpiIONAL MAIL <br />(Ste Revere) <br />~lo ` <br />` <br />t an <br />0.. Slate a ZIP Cotl ~ I ~-y <br />G J <br />1 <br />Postage $ <br />CenAietl Fee <br />Special Delivery Fee <br />Restnctetl Delivery Fee <br />Return Receipt .9. <br />to whom and <br />Return Rec s wing to whom, <br />Date. ano r s of Delivery 'o <br />TOTAL P lags pr(~@e~ 6 <br />i <br />M <br />Postmark o ate <br />POStmark o ate ~ <br />-~_~ g <br />, <br /> <br /> <br />