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" SEND <br />•ConTpINBItsTM 1 end <br />• •Canpsta Items 3, 19, <br />• Pdm your name eTM e <br />um to you. <br />~ •AttedT thb roan to the <br />pamst. <br />• Wnb WeNm Rsoipf R <br />•TM Ralum Receipt will <br />C ~a,.e,a. <br />ANcle Addressg~ <br />~~1`1 <br />5. Received By: (Pd <br />e 6. Slgnatur : (AQd <br />X L~ l <br />Or z for stltllaorW BBrNCBB. <br />erN Ib. <br />tltlrass an the Tavares of this brm so thst wB <br />from d tM mellpao, or on tM Mrx II Bpe <br />pusatetl'on tM meilpiece bebw the article <br />show Io whom e1B ertMJe weB deliverM M <br />1` _T ~.~ <br />~~ <br />~ ~'~BOs3g <br />nt Name) <br />e or Agent) <br />~,12P~1 <br />PS Form 3811, December igg4 <br />I <br />~I <br /> I also wish to receive the <br /> following services (for en I <br />T;n nMUm t1BB eztre fee): <br />tloes nd ~. ^ Addressee's Address <br />numbers 2. ^ Restricted DeIIvOry <br />tM tlale 1R <br />~ Cunsuii pushnasier for fee. <br />~I~D`~ef51 ~1 ~<<~ ~ ~ <br />4b. Service Type <br />\ <br />l ~ i <br />} <br />5 <br />^ Registered <br />Cerilflad C <br />/ <br />~ <br />^ Express Mall " ~T Insured <br />^ Retum Receipt far Merchendse O' OOD ~ <br />7. Date of Delivery <br />~~~~~ rs <br />tl <br />~ <br />T <br />B. Addressee's Address (Onlyll requested 'r <br />end !ee Is paid) <br />F <br />102595-97-8-0179 <br />~x <br />Z 1$~e8.1 <br />us Poslal s0rvicq~, ,~~~ ~,~-e~~~BfF~- ~ <br />Receipt for; Cl~'tfifit J <br />No Insurance Coverage Provided. <br />Dg„not use for lmemadonal Mai11See reverse) <br />f ei.~in ~I'T-I ~. <br />CeTtfietl Fee <br />Delivery Fee <br />Reshided DeFvary Fee J <br />Retum Receipt Shonina to <br />When d Dete Delivered `2~ <br /> <br />TOTAL Pos7ege 8 Fees I ,b' ~' <br />I~ <br />rV <br /> <br />n <br />LL <br />a <br />