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aSENDER: 1 also wish to receive the <br /> •Complete items 1 and/or 2 for additional services. <br /> e .Complete items 3,4a,and 4b. following services(for an <br /> m -Print your name and address on the reverse of this fan so that vvs a retum this extra fee): <br /> card to you. ai <br /> j -Mach this form to the from of the mailpiece,or on the back tl space doetrnot 1. ❑ Addressee's Address ° <br /> permY •W e"Retum Receipt RB uested'on the mail ece below the article number. 0 <br /> o P 4 a 2. ❑ Restricted Delivery <br /> -The Return Receipt will show to whom the article was delivered and the date y <br /> delivered. Consult postmaster for fee. ° <br /> o � <br /> ai 3.Article Addressed to: 4a.Article Number o <br /> d YYlr (7-0&64C_Wtf-P, 8e_ Z I'M /ao Qe41 E <br /> E kyw4 b.Service Type <br /> °° (�Q 6t- �7 Registered Certified <br /> u 7 b 1 Express Mail ❑ Insured <br /> _ `' 1 8� ''' l7 Retum Receipt for Merchandise ❑ COD <br /> 7 Date f Delivery <br /> it r, <br /> _ Y <br /> 5. 'v : (Print Name) 9.Addressee's Address(Orin i/requested � <br /> L ram, and fee is paid) i <br /> F <br /> g 6.Sig at : (Addressee or Agent) <br /> ° X JA <br /> PS Form 3811, December 1994 Domestic Return Receipt <br /> Z 192 120 984 /K <br /> US Postal Service <br /> Receipt for Certified kil <br /> No Insurance Coverage P..d3 <br /> O Do not use for International Mail 9 AY�vers <br /> U to`]t'lr Pipill rvLe_- Pr+t!e_. <br /> 01 Street&Wmbdr <br /> Post Pffim. ZIP Code <br /> �j '" CD �075� <br /> Ln Postage s . -7 7 <br /> N Certified Fee <br /> QSpecial Delivery Fee <br /> Restricted Delivery Fee _ <br /> N <br /> E m Return Receipt Shoving to <br /> Whom 6 Date Delivered r• V.'�/- <br /> C0< Realm Rddresees bWlnon, yJ7/1 <br /> r/�Q Date,8 Mtaaee's tl <br /> r0 TOTAL Postage&hk $ 2: <br /> Postmark or Date <br /> ILL <br /> € 3� 5 <br />