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" a Complete items 1, 2, and 3, Also complete ' <br />Item 4 If Restricted Delivery Is desired. <br />^ Print your name and~address on thereveree " <br />so that we can return the card to you. <br />^ Atlach this card to the back of the mafiplece, <br />or on the front If space permits. <br />:~ 1. Article Adtlressed to; <br />W~ F, C lou~h <br />Po, gox ~S~) <br />~{-~~, Cc~ g~~~o-~~g~ <br />Agent <br />X' <br />dresses <br />8, Recelv by (Printed Name) C, pate of Delivery <br />C~~ ~-i . ~,~n l oa R ..:~, <br />D. la delivery addresstllt!l~enfirom Item 17 ^ Yes <br />It YEB,.enter tlelivary adtlrass below: "^ No <br />3: Service Type <br />^ CBrtlfled Mail ^ Fxpres9 Mail <br />^ Registered ^ Return flecelpt for Merchandise <br />A. Restricted DeliveNLr~^ Fee)" ^ Yes <br />2. ArudeNumber .pQS 184 3619 <br />(fransferhom sen' 7 (_] ~ 3 3110 ~ <br />PS Form 3811, A "~ Domestle Rstum Receipt iozss5-oz•NVts4o <br />~ Complete Itema 1, 2, and 3'. Also complete <br />Item 4 If Restricted Delivery Is desired, <br />^ Print your name end address on the reverse <br />so that we can return the card to you. <br />^ Attach this card to the back of the mallpiece, <br />or on the troll If space permits. <br />1. Article Atldrassed to; <br />C~+y o~C~~i~ <br />~~, Uox Iqo~ <br />X ,_,// ^ Again <br />~ Addressee <br />B. slued by (1?r! t Na e) ~ C. Date of Delivery <br />f' ~ ~ ~ - -o <br />D. Is delvery dress different from kem 17 ^ Yes <br />If YES, enter delivery adtlrese below: O-No <br />{~~1 {(((~~llll (M~ ~o _ 3. Service Type <br />' 1 ~ i I ~ I ~ ~ `" I ^ ~ O ^ ~ C~ O ~ O Regf f~reMall ^ Relum Receipt for Merchantllse <br />^ Insured Mall ^ C:O.D. <br />4. Restricted Deliveryi (ExhaFeeJ ^ yes <br />z. ArticleNUmbe 717p3 311 0005 1084 3602 <br />(rrensfer rrom <br />PS Form 3811, August 2001 Domastlo Return Reoelpt ~ tozsesoz•ra4sao" <br />