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senvels: <br />• Complete items 1 and/or 2 for addi[ional services. <br />I also wish to receive [he <br />• rdfete items 3, and 4a & b. '~ following services (tor an extra <br />+• ~`~ your name and address on the reverse of this form so 1ee1: <br />Shat weya~ return this card to you. 7 <br />^ Addressee's Address <br />•,. Attach this form to the front of the mailpiece, or on the , <br />tiack iF.space does not permit. <br />" <br />" <br />^ Restricted Deliv <br />2 <br />r <br />• Wrfite <br />Return Receipt Requested <br />on the mailpiec e next to . <br />y <br />e <br />tfie article number. Consult postmaster for tee. <br />3. Article Addressed [o: 4a. <br />A <br />cle N <br />umber <br />- ~ <br />~ /, ~ / / <br />_ <br />O <br />V <br />IND DEPT OF NATURAL RESOURCES ab. Service Type <br />^ Registered ^ Insured <br />DIV OF RECLM ~Certitied ^COD <br />PO BOX 147 ^ Express Mail ^ Return Receipt for <br /> Merchandise <br />JASONVILLE IN 47438 7. a e of Deliverv <br />5. Signature (Addreseeel <br />6. Si nature (Ag <br />P;~m 1, <br />~' ~ 9- ~ ~ <br />8. Addressee's Address (Only if requested <br />and fee is paid) <br />•us. dPO: taco-naem DOME5TIG HETURIV RECEIPT <br /> <br />