ll i • ~
<br />7 ~ ..a _ i s ul B r rr,
<br />~~i(
<br />
<br />~
<br />6~
<br />e
<br />~
<br />1~
<br />e .
<br />_ F^.f
<br />p ~
<br /> '~ p s ~aa
<br />~• ~. ~~ ;
<br />r9
<br />`~ ..
<br />d.'~~~~4~at. u
<br />~ u,f+~1 ~
<br />__ :. .s ... r9
<br />D'
<br />i
<br />J6'T,u3E
<br />C.3 Efi~~l
<br />. , ,
<br />~.. EFrC _.
<br />~C O•
<br /> ~ .
<br />.
<br />
<br />frl
<br />p
<br />t
<br />$ 4.~~ ~ R'1~'C2 ~'~~,
<br />)~
<br />p
<br />i v.~~ Q,iii iU: aG=Qi\
<br /> os
<br />age Q f
<br />t Ppsta e
<br />B $
<br />p tp p v
<br />
<br />~
<br />Certified Fee
<br />"-`
<br />~
<br />0
<br />Certified Fae
<br />"` (~
<br />SE~ ~ 1 /UQ
<br /> -
<br />+~ ~
<br />Pos4nark v 9
<br />ostlnerfc
<br />p FiaWm Receipt Fee
<br />(Endorsement Required[ ~ ~~ ~. are
<br />~
<br />/
<br />'j O Return Receipt Fee
<br />tl
<br />R
<br />i -. Here
<br />,_p ~;i
<br />,
<br />/(//1~
<br />.er (., f~
<br />1 ~
<br />- ~ (En
<br />orsemenl
<br />equ
<br />red r.. ._ , .~_,.
<br />1
<br />t K" i~('
<br />iC~r
<br />~ Restri
<br />d Delive F
<br />t (
<br />~ to ~
<br />~
<br />i
<br />;
<br />
<br />p c
<br />e
<br />ee
<br />7
<br />(Endorsement Requlretl) = r •
<br />' : `~ " '
<br />p RestdMetl Delivery Fee
<br />d
<br />i
<br /> n
<br />wsement R u
<br />re S
<br />(L TWal Postage&Faoa ~ "`4t Jir ...
<br />G
<br />S
<br />f11
<br />Tata(POatage&Feea Q
<br />W „ii" ~~
<br />- _
<br />~1~~`~
<br />p PC p
<br />p
<br />r` Sent TO
<br />I B.r I.'p C ~
<br />Mr,_
<br />e,aoF Ggh p
<br />i r`
<br />mreep apt. na.; ~ "D
<br />or PO Box NO. ^~Q ~
<br />---------~-- ------------ -- --• -• .~-- ----------...-----------
<br />qty, Stete, ZIPi 0
<br />Mo~~roSP_ GG' t5i" a/
<br />:r, rr
<br />~ a
<br />~ .. -
<br />0
<br />S ~i
<br />rH
<br />~ Postage $ `~[ Q~•[` ~~
<br />~ Certlfietl Fee =•~` O4~
<br />p SEP rPaavnerk ,..,
<br />p Reurn Receipt Fee i . ~ J
<br />~ (Endorsemem Rewired) _ _ erel..l
<br />~ Restricted Delivery Fee -_c; K: MvFiu@f'`U~1
<br />p (Endorsement Required)
<br />N Total Postage & Fees ~ "'_ ' ~:~ ~ !i_iy
<br />p ~, ~SPg
<br />p Sent To ~ ~
<br />M1 ~ e
<br />wW 2r T
<br />.__.....___...___ _..._._..__......(S~:_ ._ .
<br />SVeet, Apt. No.; _S r , Cru, N r~J
<br />or PO Box No_....._~_°:.~ :5..._.._...(....`~7......._.___ ....................
<br />Ciry, Btete, Z/Pr4 /~„ r ~ /(1-!~'j/~G'
<br />IV,Jn t7lr. W n
<br />rv
<br />m
<br />0
<br />S ~ ...' elk i r.,,,"u' °:w'_ .. .,..
<br />Ut:., __:._,.
<br />~,~ Postage
<br /> ER L
<br />~ Certified Fee ~"~-
<br />' Q EJ
<br />QP~Y
<br />
<br />p
<br />Realm Rece1P1 Fae ~
<br />i ` ~ `~ Postmark , ,
<br />Here ~'\~.
<br />~ (Endorsement Required) ~ ~ t
<br />`~'
<br />jf
<br />~ Restricted Delivery Fee ~ 7
<br />
<br />O
<br />(Entlorsemem Required) 1 (
<br />J U(,~
<br />IL
<br />IDtel PpstegeHFees @@
<br />p ``~`
<br />ii':'%iilr~Vk
<br />p
<br />p Sent Te .~-
<br />J ~Mas C D, P„
<br />~
<br />
<br />
<br />Streeq APL Na.; -T -- ..
<br />PO B
<br />N
<br />SU ~
<br />aeG
<br />i~ _
<br />_._
<br />
<br />~
<br /> or
<br />Ox
<br />O.
<br />j
<br />~ ,
<br /> ........................... .........._........._..
<br />City, Btete, ZIPf 4 M a^ I , [,CSC ~.G ....y..__......_.__.....__......._._,.
<br />V
<br /> "4 s
<br />[?05[01 SONiCe~:: -- <
<br />t1
<br />S - ~
<br />?~ ~ ,
<br />?,
<br /> .
<br />.
<br />ECEIPT ~
<br />= '
<br />` ~~
<br />
<br />• :CERTIFIED MAIL R -
<br />' :
<br /> (DOmestrc Mad.Anly No Jnstirance Cov erage Provided) ~'
<br /> ...; . _..
<br />
<br />
<br /> [
<br />
<br />
<br /> ""• _ Ni' ': r"'.
<br />~ ~ ~
<br />fTl Posta9e $ . ~
<br />Postage
<br />$
<br />~
<br />
<br />p
<br />~
<br />
<br />Certlfietl Fee
<br />v R CO
<br />E 8\ p
<br />p
<br />Certlfietl Fee ,. ,.;
<br />~~•- Q
<br />, ~a
<br />~~
<br />
<br />i !~. J
<br />Posimalrc
<br />
<br />p
<br />
<br />Rehm Receipt Fes
<br />.i . ~~; ~
<br />v7
<br />Postmerk
<br />
<br />O Return Receipt Fee
<br />
<br />(Endorsement Required) Hete
<br />
<br />r~
<br />iwt~^
<br />.
<br />~
<br />,~
<br />(Endorsement Required) Here
<br />
<br />~:
<br />--
<br />~
<br />-
<br />~ t
<br />y:..
<br />~.
<br />_,,- a,
<br />...
<br />:
<br />,-
<br />' i r:
<br />.L
<br />;
<br />f
<br />r
<br />`
<br />~ Restdctetl Delivery Fee S [[~~
<br />F ~ ~ LUU4 ~
<br />[~ Rnhkletl Delivery Fee
<br />(Endorsement Required) ..
<br />..
<br />:. ~
<br />:,
<br />~j
<br />p (Entlorsement Required)
<br />s
<br />t
<br />d F
<br />T
<br />l P , _
<br />
<br />ti
<br />
<br />Total Postage S Fen
<br />
<br />~7 , _
<br />~SP
<br />fL ee
<br />os
<br />age
<br />ota p
<br />O ~
<br />p
<br />f` ent TO
<br />L0. "J~Q,~Ip
<br />/'~~~':'
<br />~,~~?~`,rv?S ~-~:~.._.
<br />.~ ~ Sent TO -,
<br />. ~:acr To~~ F
<br />h ~t.n..r~A~had-q IT
<br />'L API. No.; R 'Yq, I `~ w PO Box No. (v // 5 ~ ' V
<br />7BOx No. F~ ~~a>< L(L!^ .__...... _....__ _._._._...__.__.__`?...~.Jr._1......_L O:.._~.~..1~..._P...
<br />....._....... ..... ... ............._.... C1tY, Stete, ZIPa 4
<br />sieie,zir.a ,,, ,. L.,_T. ~n GL^~m~ M.n.l._~a rn kYJnl
<br />otin3800,`Apri121102, ~,'r~:`H'~ ~eetieVerseSOrlnsWctions ra r0rm:7t1(IU;ApnfZBBZ ,.;a:,.', ~,~., :;='.See`Reverse foMnstruetions~.E1
<br />
|