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;; SENDER: <br />a .Complete items lan0/or2lor addit~onat services. <br />.Complete items 3, 4a, antl 4b. <br />d • Pnnl your name antl atltlress on the reverse of ihrs form so Thal we can reNrn Ibis <br />'^ Lard to you. <br />v • Attach Ihis form to the Iron) of the mail0~ece, or on the back it space does not <br />N V;,nnd <br />~ • Wnle 'Reurn Recerp! Requesfed'on the madpiece below the article number. <br />L ~ The Return Receipt will show to whom iha article was tleliv¢Rd and the date <br />• tlelrv¢red. <br />C <br />I also wish to receive the <br />101(eWing SeNiCBe (10f an <br />extra fee): <br /> <br />1. ^ Addressee's Address ei <br />2. ^ Restricted Delivery w <br /> <br />Consult postmaster for tee. n - <br />0 3. Article Aodres o: <br />~ 4a. Article Number <br /> a.~~~~~ <br />~-~~Lra z i4a 1 ~y y <br />n /`~, l~~d(\~ .C f'1-R. ~O~'t/~ ~C <br />11 <br />d.(,~- 4b. Service Type <br />u ` I,.,,' i_]_, <br />~ ' <br />J <br />"`C(~C~`~l <br />~~13 ~Jl-LC~~~-c~rC <br />~ ^ Registered <br />^ Express Mail <br />m - <br />T <br />~ L~ sl I ~ ~V Ln 3G i <br />~ t LV l~ ~ ^ Return Receipt for Merchandise <br /> , 7. Date of Delivery <br /> ~ :S f1U <br /> 5. Received By: (Print Name) 6. Addressee's Address (Only <br /> and lee is paitl) <br /> 6. Signa)ure: (Address a or Agent <br />o' X ~ <br />T <br />m <br />PS Form 11, December 1 <br />102595-a8-B-0229 Domestic Rett <br /> <br />~("~~ <br />~ Z'192 124 469 m `~ <br />~ US Postal Service ~ <br />o Receipt for Certified Mail ~ ~ <br />~ No Insurance Coverage Provided. <br />Q Do not use for International Mail See revers <br />() Sent to I 1710 <br /> <br />> Street d Number '11 <br />4( <br />l3 ~ <br />~ 0 <br />2 r rn <br />O Post Olfi~, $lete, 8 ZIP Coda <br /> ~lL ~~, <br />~ PosWpe a .~ <br />N <br /> <br />E Certified Fee <br />Q Spedal Delivery Fee <br />C <br />07 <br />fins4ided Detire <br /> ' <br /> N7rom Dad Grera ~ <br />C/Q sv.rq <br /> "~~ <br />Daro,d <br />TOT r8q;p Fees o <br /> <br />.F Postmark or0ate_ ~ v~ <br />; ;~. <br /> <br /> <br />U <br />D <br />~ " <br />E <br />Cerlllled <br />^ Insured ~ <br />^ COD ~ . <br />`o <br />0 <br />requested x <br />c <br />m <br />L <br />r <br />