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0 <br />Z 268 18~ c <br />US Postal Seri C ~ 3 ~ <br />Receipt f' ' O <br />No Insurance Coverage Providetl. C.,) <br />n L.. Inlnmelinnal lutail /.SRR /RVR2NI <br />u <br />oa <br />c <br />a <br />O <br />u <br />c <br />- ~~ <br /> <br /> c <br />et 8 Number ~~QQ <br />~ ~~Y 0 <br />~ G <br />Office, State 8 ZIP Cpde~ ~) ~~ (n <br />O /~.~ ~~ N <br /> <br />Postage E <br /> l <br />Certified Fee ~ <br /> <br />Spedal Delivery Fee <br />~ <br />° q' p <br />E <br /> <br /> <br />Resbided Delivery Fee <br />(l ~.. <br />t <br /> <br />', Retum Receipt Showingt Bss ~~, (~ <br />Whom.B Date Delivered C"~ <br />Rerom Racept 5hoaingroyAlom, r" <br />~ <br />Date,8M6essees Md~ass T <br />ToiAL Postage 6 Fees <br />I $ ...2~ !R <br />V <br />t Posbnark or Date ~. <br />i ^ <br />Q <br />I <br />e SENDER: <br />9 •Comdets Items 1 end/ar 21or addltlorW aerMCee. <br />e •COmdete Hems 3, Ia, end eD. <br />o • Pdnl your name and sddnroe an Ina reverse of tme brm so Wt we Can Mum tNs <br />= card b You. <br />•Mecn dtls brm to the Nord of the rrW Idea, or w the bark N spas awe not <br />e Perms. <br />• • Wdte'Refum Receipt Rpuested'w the meildea below the enkls number. <br />•The Relum Rxelpl will show to whom cep erlltle wee dallvered entl the tlete <br />~ dANand. <br />0 <br />0 3. Artlcle Atldressed to: <br />~~~ L t]cCLv' <br />E ~wl~~ ~esou-rtes L+1 <br />~I U l30 S~ )4~ '/ <br />~O /1.~G., ~ CG 8I 7 Z~S <br />5. Received By: (Pdnt Name) <br />~ 6. Sf re: (Add ssee nt <br />T X ~t <br />• PS Form 3611, December 1994 <br />•_ <br />I also wish to receive the <br />following eervlces (for en <br />aXtfa fee): <br />1. ^ Addressee's Addreea Z <br />2. ^ Restdded Delivery rR <br />ConaWt postmaster for fee. ~ <br />^ Registered <br />^ F~ress Mall <br />^ ReNm ReoelPt <br />~9nd !ea Is pe/d) <br />102595-91~a0179 <br /> <br />?33 8 e <br /> <br />^ Certlfled <br />^ Insured <br />terlmse ^ COD <br />/~- <br />' o <br /> a <br />(Onty I! requested ~ <br />t <br />t- <br />