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P Sc'6 4138 844 l~ <br />USP ~ ...:. ~~" ':j <br />R~ ified Mail <br />I9G I e Provided. -b <br />o n rem nal Mail ee reverse ~ <br /> <br />t <br />G <br />a <br />i <br />u <br />0 <br />~~ <br />~ d ~ N <br />fc~Wer 1 <br />to IP~~ 9 f (a3 - <br />- <br />Poslape 3 ~ <br />Certified Fee <br />Spedal Deliveryfee ,. - <br />Resirigetl Delivery Fee <br />~ Retum Flocee~`ry1 Shokktg t0 <br />' Whom d Dst$ Delivered <br /> <br />_ <br />} Ream IleCgil gyYAnm. <br />Dm,Bnm~~essee9wtlmss~, <br />TOTAL Postage 8 Fees <br />a '- <br />F <br />~ Pastrnark or Date <br />~ n SEN~eR: <br /> <br />v <br />Complete ilema 1 anNor 21or edtlitional eenecea. I also vdsh to receive the <br />n .Complete items a, aa, and oe. following services (tor an <br /> ewrd tooyou.~e and address on the reveBe of this brm so That we can return this aXtra tae): ~ <br />> eAtlach this form to the hoot of the malpiece, or on the batlc it space Ooea oat 1. ^ Addressee's Address ~ <br />~ <br />m •Wd eI ~Rerum Recei f Re uesred' on the mail ece below the article numoer. <br />o v w 2. ~ Restricted Delivery m <br />y. <br /> <br />C aThe Return Receipt will show to whom the anicie was delivered eM the date <br />delivetetl. COnSUIt pOShr1a518r f0(fee. <br />6 . <br />O <br />~ 33.nnArticle Addressed to: //,~~ <br />U 11i(~~ <br />1 <br />a <br />~CC7' ~ <br />4a~rtiCle N~ bet ~ ~~ <br />5 JlS_l m <br /> <br />E <br />~ <br />_. <br />VC <br />l <br />u ~ ~~ <br />"~. ( <br />~'~ / ~ 4b. Service Type <br /> <br />^ Re <br />istered ^ Certified <br />m <br />do <br />rn <br /> <br />~ ~ <br />, <br />t f ,A ~\ I <br />c~7 <br />~ 1 ~3 <br />. t <br />C <br />~ ~ <br />~ g <br />^ Express Mail ^ IDSUred <br />^ Return Receipt for Merchandise ^ COD rn <br /> <br />~ <br /> ~ <br />lJ <br />-1 <br />Y `~ <br />D ` <br />. 7. Date of Delivery <br />~/~Iq <br /> <br />~ 5. Received B : (Print Nam 6. Addressee's Address (Only it requested ~ <br /> and lee is paid) - i . <br />g 6. Signatur . (Addres orAg <br />T X J <br />A <br />PS Fo 3811. December issa <br />Domestic Return Receipt <br />