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o-SENDER: <br /> v Complete its"t andlor 2 for additional services. I a150 wish to receive the <br /> d •Complete items 3,4a,and 41b. following services(for an <br /> e •Prim your name and address on the derisive of this form so that we can return this extra fee): <br /> card to you. i ai <br /> -Attach this form to the hoot of the mailpisce,or on the back if space does not t, ❑ Addressee's Address 2 <br /> o permit. d <br /> d •Wdte'Retum Receipt Requested'on the mailpiece below the article number. 2, ID Restricted Delivery y <br /> y -The Return Receipt will show to whom the article was delivered and the date <br /> delivered. Consult postmaster for fee. n <br /> 0 <br /> 3.Article/Addressed to: u , 4a.Article Number <br /> a �, J/�/ z 4 Z Z�S <br /> °u �/ �K /G(.i CI Service Typo <br /> a <br /> n ❑ Registered Certified 01 <br /> W ❑ Express Mail ❑ Insured m <br /> w (� ,t �yD�� ❑ Return Receipt for Maichandise 0 COD <br /> Date o D ve <br /> z Q=' tiA Z a°. <br /> 5. eived By: (Print me) _� %. Add ee's Address(Only it requested <br /> LU <br /> �•• nd tee is paid) m <br /> F <br /> N 6. ignature: (Adclinassileor Agent) 1, �!✓„U� <br /> N <br /> PS Form 3811 d December 1994 Domestic Return Receipt <br /> Z 416 942 260 // <br /> Rec�k /� <br /> _`W 20!1 T.[q*c iezi_ <br /> ��mtem <br /> n for r <br /> O00 E Cendied Fee <br /> 0 <br /> LL Special Delivery Fee <br /> m <br /> a <br /> Revaeded Delivery Fee aC <br /> Return Receipt Snowing <br /> 10 Whom 8 Date Delivered <br /> F¢mrn flec"o Stowing 10 Wham. <br /> Dais,entl Addressee's Add,ess <br /> TOTAL Postage J <br /> g Fees S <br /> Postmark or Dale <br /> ;n <br />