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n. <br />v SENDER: <br />y complete it*fi an9lpr Ziar addil6NaA SPJ*fid?s;" - - -~" r also wish to receive the I <br />to CompYete items 3, and da 8 b. ... ,_„ following services (for an extra ~ <br />• Print your nape and adtlress on the, reverse of this Form so that we can feel . •~ i <br />d return this cardYtl you, <br />• Anach this Corm to the front of the mailpjpce, o. on the back dt space 1. ' ~ Addressee's Address fjj <br />does not permit; ~^ =i"]] ! <br />V • Write "Return Receipt Requested" on the mailpiece below'tF.e article number. 2. ^ Re5[flCted De1lVely G~ <br />• The Return Receipt will show to whom the article.was delivi?ied and the date ro <br />o delivered. ~ Consult postmaster for fee. d <br />v 3~f~JA{lrticle Addressed to; 4a. Article Number <br />a T~_~e~r ~~~~ 4b. Service Type Q ~~ <br />p ~[C~^~ R/e~istered ^ Insured <br />y ~3/ n ~~,.~ ~/tt Ll~'Certified ^ CODM1~ y' <br />uyj ~YT\ ^ Express Mail ^ Retuin Receipt for ~ <br />~l..V C'~S-~~ `1 Q ~(~~ Merchandise <br />~ 7. Date of Delivery ~ / <br />a o~ <br />r <br />~ 5. Signatu fe•(A dresseel " ~ 8. Addressee's Address (Only if equested x <br />~ ~//, /-' ~ /~~~~~~ and fee is paid) ~ <br />~~6~ Signature (Agentl' ` ~ <br />G <br />Y <br />i rj ~ ~, :' .~v",• M1~~~"...t:ne••Pi~fid ~Xrtl: ~`~ ~~. <br />