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Z 268 234 <br />US Postal Service CG <br />C " <br />Receipt for Cc~}r {~~ <br />No Insurance Coverage Provided. <br />Do not use for International Mail /.soo .a~aT,.~ <br />Postage ~ '1 "1 <br />~ <br /> / I <br />Codified Fee ~ (,~P q r <br />d F. <br />Speaal Delivery Fae $ S <br />Restdded Delivery Fea <br />N <br />m Return Receipt Showing to <br />whom d Dale Delivered <br />p fleNm flecept Shaw'vg to WMm <br />, <br />a Oate, d Addressee's Address <br />C <br />~ TOTAL Postage d Fees <br />Postmark or Date <br />0 <br />LL <br />N <br />a <br />o SENDER: <br /> <br />a <br />•Complete items t BrW/or 2 f« atldilioral eervicea. I also wish ro receive the <br />O <br />4 •Complete items 9, La, entl 4b. <br />• Prim your name and edtlraea on the reverse of this bnn ao Ihet we can return Inie toIlBWing SBrVICOS (tor 8r1 <br />Bxtfa f00~: <br />C <br />e uN to you. <br />•~~n this Mrtn to the horn o/the mailpieca, or an the back it apace dose not <br />t, Q Addr05SBe'S Address <br />Z <br />p •Wdte'Retum Receipt Requuted'on the meilpiece below the articlaftumhec 2. ~ Restdcted DBtiVery N <br />$ <br />e •The Return Receipt will show to whom the ertlde was delivered anp~the dNe <br />dvrerad. <br />Consult postmaster for fee. <br />_TL <br />v 3. Mlcle Atldressed to f 4a. Article Number <br /> Q <br />~~ ~~ <br />~ <br />~ 3y E <br /> C <br />~ <br />~ ab: service •rype d <br />~ ~ C ~ l] ~ ~ -7S`, / <br />7 ^ Registered •~ • _,,,,. ++~^. Cer)iiled <br />^ E <br />M <br />il <br />s <br />bd <br />' m <br />5 <br /> xpress <br />ln <br />a <br />ur <br />1 <br />L.I <br /> <br />~' r~r~~~ /Ij~ p-/ r /~ p _ I7( <br />r r° <br />= ( <br />V O T 0 J ~ <br />^ Return Receipt~biMe(ctWWise:,~] C4D e <br />o <br /> . <br />~ <br />pct I l err 7. Date of DBlivery ~~ <br />~ <br />° <br /> ~. <br /> Received ~ (PrintNameJ 8. Addressee's (Onlyilrequested ~ <br /> n ~V1 end lee is paid) - ~ <br />g 6. Signature: ressae or Agent) <br />~` <br />A X , <br />PS Form 3817, December lase 102595-91~B-0119 Domestic Return Receipt <br />