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SENDEp: Coftlplna iufrla 1, 2, 3 and 4. <br />Put your atltlr¢ir in the ''RETURN TO" space on the <br />ravarsa aitla. Feilura to do thir will.Drarant thir card Tram <br />bairp raurnaa to You. ~([a return racabt lea will prpYlda <br />You the name of the parson WlirNad to arq the data of <br />dNirNr. For adOltlonal load Ma followin0 tarrkw an <br />availaCle. Conwlt ppatmeatN for fN and chock boxlaa) <br />tot sarvica(el rpuanatl. <br />1. ~ snow to wean, data and atldraa of tlNhary. <br />2. ^ Rgtrictad ONivaty. <br />/ <br />9. Articb atlrarsad - <br />mr . ~rc~ 6ccrn.. <br />m., le.,n Sow~n~;ek. <br />x.6021 'lam LI,~tS~ ~LS~h~au~,• <br />L.o~e~~Q Co• ~5053~ <br />4. TYDa of S.Nrica: Article Number <br />~ fiegisteretl ^ Inturad <br />~CNtified ^ COD <br />~ O68 07'7 8~1~(. <br />ExPresf A6i1 <br />AlwaYS obtain aiyutun of nddresxags9ant and <br />DATE DELIVERED. <br />5. $i stun - Atldra4aa <br />x ~ <br />6. Sipnatura - Apant <br />x <br />7. Data of Daliwry <br />'~' ~/ ~fS <br />8. A re• M's Atltlrps~Qjlr lKQYQf O K{1P <br /> <br />41 <br />~ <br />~+ <br />~ ~Lrt~ <br />w <br />0 <br />3' <br />8 <br />O <br />N <br />y <br />A <br />a <br />c <br />a <br />2 <br />n <br />9 <br />I <br />y <br />S+ <br />>.i <br /> <br />0 <br />Q <br />V <br />~S <br />~,j <br />h1 a <br />Y) <br />~~ <br />~a <br />Q <br />~~ <br />~g <br />.~ <br />~u <br />0 <br />P 068 279 835 <br />RECEIPT FOR CERTIFIED MAIL <br />NO INSURANCE COVERAGE PROVIDED <br />NOT FOR INTERNATIONAL AMA~I~ ~ <br />fSee Reverse) li ~ <br />cant to mom. ~l cn- <br /> <br />treO ~{[tl No. ~; <br /> <br /> <br />P.O., State antl Z P CoOe <br />O <br />p y.rt <br />`~~ ~ ! ~ <br />t <br />Certi ie ea <br />Special DegV171Fee ~ f. <br />Reslricled Delivery Fee <br />r! :r t 111 <br />five[ <br />i Return receipt snowing to whom, <br />~ <br />~ Date, antl Atltlress of lib <br />TOTAL Postage <br />[ Postmark or to { R1 <br />~.. <br />Z <br />~ <br />,~c <br />~ <br />^~ <br />~ <br />h <br />Y <br />~~. <br />i <br /> <br />