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<br />~J <br />" SENDER: <br />•Canplaa 11•rt• 1 eeWOr 2 br eddilionel wMCe•. I de0 vrlsh f0 reCBIVe fie <br /> •comga• itsma s, v; erid ab. fdbvring services (for an <br /> •Pdn your nem• end eddrese on dw oven. of ltlis form eo that we cen ream thi• extra fee): <br />prd t0 you. <br />p <br />` •Ad•cn dbe roan to the hon of the mellpi•p, ar an Iro bee it apace doe. rat 1. ^ AddreSS66's Address •Y <br /> •W~n eWaum Receipt Requee,ed'on the meipNCe bebw IM •rtkp nunihar. 2. ^ Restficted DBIiVery <br />.The Raum Racwpl rill show to wtgm the ertlCl• wu tlNiVa•tl end Ih• data <br /> <br />i • . <br />dalvxw. Consult postrnaste <br />r <br />fo <br />r fee. <br />i ~sed tp: ~ 4a. Ar~fcle Number <br />h le Arldr <br />~ <br />i <br />am <br />/ <br />•.~ <br /> _ <br />~ <br />~Llzk ,[, .c <br />-t <br />C_~8 <br />~cu <br />~33 ..tCi 2-- <br />Gf <br />N~ <br />E <br />a <br />3 L <br />,t, <br />~(,S~CC, ~CLI(11 ,rt 4b. Service Type <br />^ R <br />i ~ <br />~ eg <br />stered Cerfified <br />~! ~~_~ n ~1 ~L~~„f{ ~, /1r LCLL <br />"u <br />w`K/ sU• ^ Ex <br />t_.cCO e0[.o L lh <br />r <br />" <br />ress Mall ^ Insured a <br /> p <br />~ <br />~ <br />" <br />/ <br />6'f"9 5 e t_,tx,4a4 ^ Retum Receipt f r rdia($e COD ~ <br />' <br /> Cdo~,~d ~t , Co ~ ~~ r9 ~ Date of Deli~• Mq <br />~ ~ <br />r <br /> R <br /> seal ey: (Print Name) 8. Addressee re lyi/r q~ tad <br />i <br />and !ee is Id) <br />~'~ ~ <br /> 2~0p <br />e r <br />~ <br />>, 6. Sign : (Addressee or Agent) V <br />sPS <br />X Ca <br />e ~ <br />~ <br /> - <br />-..~,~ <br />- <br /> PS Form 8011, I~anrMr,9P{ ,oa•seT~-0,79 rnestic Wm Receipt <br />• Z 268 23?2 ,1 <br />~F~• <br /> n1-19'7~f-. /,•,,.~,-,~. <br />US Postal Service <br />Receipt for Cer I~~~Aait <br /> No Insurance Coverage Provided. ~f <br />..., t.., i..remo,innal eAail /Rwe reverse) V <br />u <br />c <br />:; <br />C <br />e <br />C <br />I <br />i <br />t <br />4•~ <br />nn A <br />4 <br />Ss ,} yu~er <br />"(-`~ <br />P <br />, slat zip e e tg f 019 <br />Posage <br />Ce,efied Fee F V v <br />` <br /> C <br />Spedal Delivery F `J d <br /> <br />Resldded Daive F J <br />~~ ' .i <br />Raum Receipt S N'g , / ,~ <br />Whom 8 Dale De <br />Rewm Rerepl S~q ~ <br />Dale,B Addessees Addass <br />i 70711E Postage 8 Fees <br />1 ~ ~~ <br />I Posbnark ar Date <br />i <br /> <br />t <br />u <br />