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^ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />^ Print your name and address on the reverse A. Signature <br />J~ <br />X hTA <br />^ Agent <br />^ Adtlressee <br />so that we Can return the Card to you. <br />^ Attach this card to the back of the mailpiece, B. Receive (Printed Name) C. Date of Delivery <br />or on the front if space pehnits. <br /> ^ Y <br /> <br />1. Article Addressed lo: <br /> <br />ay/a ~~- ~~ v <br />/'~Sr ~ ~OG[~r~q~.•°t D. Is delivery dtlress different frorr~¢m 77 <br /> <br />If VES, enter delivery address bow: <br />~ <br />JAN 16 ?()f1A ~ es <br /> <br />^ No TI <br />-*~ m <br />o R7 <br />(J ~-~ ` r `~^', A' /~ <br />_ 1 c//1 ~ ~l/C , <br />_/ rl. 3. Service Type ~, ~ m <br />~`Certifiad Mail ^ Express M~ O~ ^ <br />^ Regis[eretl ^ Return Rec~t for MerohanUlS4 <br /> <br />~ ^ Insured Mail ^ C.O.D. ~ <br />//~~ / <br />~On ~ LD (Y(/ (~ ~ ~ <br />~/`w 4, Restricted Delivery? (Extra Fee) ~° ^ Yes <br />2. Article Number 7003 <br />(trans/er /rom service labep 1680 0005 7084 9729 <br />PS Form 381 y, August 2001 Domestic Retum Receipt tazsss-oz-M-tsao <br />