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iiiiiuiiiiniiiiii <br />999 <br />m SENDER: <br />v •COmplete aema 1 endor 2 tw additional services. 18150 VlISh t0 reCelVe tFte - <br />0 •Complete items 3, 4a, end 4b. (ollOWing SerVICeS (for 8f1 <br />~ •Prim your name arM address on the reveree of thin form so that we can relum this BMre f9e): <br />cartl to you. <br />•An~ ltda brtn to the from of the mellpiace, or on the back if space does not 1. ^ Addressee's Address ~, <br />• Wdte'Refum Reeai Requested' on the mail ace below the snide number. w <br />m M t>i 2. ^ Restncted Delivery m <br />$ •Tha Retum Receipt will show to whom the snide was deliveretl end the date <br />~ delivered. Consult postmaster for fee. n <br />3. Artlcle Addressed to• 4a. Artlcle mbar <br />0 4 . SeMce T e ~ <br />°u ~ /"~ ~~_! p,// ^ Registered ~Certifled ~ <br />lY O~( a _a <br />^ Express Mail ^ Insured ~ <br />~j ^ Retum Receipt for Merchandise ^ COD <br />~ J7. J~~ T~ 7. Date of D1glive _ ~~ <br />O ~ <br />is <br />5. Received By: (Pdnt Name) S. Addressee's Address (Only i/requested ~ <br />and /ee is paid) i . <br />6. Signature: (Addresse or Ag t) <br />0 <br />a <br />a <br />Ps Porm 3811, December tssa ,ozsss-s,-e onv Domestic Return Receipt <br />436-784 289 s <br />r- ~ <br />US Postal Service ~ <br />Receipt for Certified Mail 16~ <br />No Insurance Coverage Provided. <br />Do not use far International Mail See reverse <br />senior ;~ _ i ~ n `~' <br />t'astage $ <br />Certified Fee "7O <br />Spatial Delivery Fea '7 <br />Rtutddetl Delivery Fee <br />n <br />~ Return Receipt Showin <br />un.,._.n_._,._... ~__ <br /> <br />0 <br />LL <br />Vl <br />a <br />