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• Complete items 1 and/Gr 2 for additional services. <br />• Cemplefe items ' nd 4e & b. <br />• Print your name address on the reverse of this form so <br />That we can return t is card to you. <br />• Attach this form to the front of the mailpiece, or on the <br />back if space does not permit. <br />• Write "Return Receipt Requested" on the mailpiece next to <br />the article number. <br />3. Article Addressed to: 4a. Ari <br />1 also wish to receive the <br />bllowinr •rvices (for an extra <br />feel: <br />1. ^ Addressee's Address <br />2. ^ Restricted Delivery <br />;fah Division <br />of Oil -1--P 179 I6S S~~ <br />T <br />e <br />s <br />G <br />355 West North <br />' <br />Temple erv <br />yp <br />as & Minin <br />9 Regis ^ Insured <br />Triad <br />r' Suite <br />'alt <br />e 350 •certi~ ^coD <br />lake <br />Cit <br />Y s Utah Express Mail ^ Return Receipt for <br />e418~ <br /> Merchandise <br /> Date ~DQlivery <br /> ~ <br />5. Si ature IAddresse 6. Addressee's A s nlyi f <br />e~quested <br />t <br />~ ~ C <br />J ~ and fee is p idY ~~ ~~ ^ <br />t <br />~ <br />i <br />6. Signature (Agent) ~ ~~ ~ i~~ <br />c /-.1 <br />Form Jl377, October 7990 aU.S. GPO: tti-D-27aeet <br /> <br />1 <br />3 <br />G <br />c <br />c <br /> <br />S~ w~ <br />~~~~0~~ Z79 Z65 597 <br />ail <br />verage Provided <br />Q~u>i'RE. Do not use for International Mad <br />~ ~ ISee Reversrll <br />Receipt for <br />~ Certified M <br />C No Insurance Co <br /> Sen~~owt~0/NINCr <br />C>~ C' rv ~ (i. /ytQ}J <br />,1! <br /> Sne~ana No / q" <br /> <br /> P~ Sldle 3ntl iIP Cone <br /> <br />C e. J <br /> Posla9e <br />u c~ <br />E Ce,uLetl Fee t <br /> SPeaal Del~..erv lee <br />b eesmuetl Del,.e~y Fee <br /> <br /> flelwn Heceml Snowing <br />L la Wnom 6 Dale Dee..e~etl <br /> <br /> flelmn Feceio~ Snowing ~o WM1Om. <br /> Dale. ano gtltliessee's Atltl~ess <br /> 'ol Povage <br /> <br />~ ea <br />a Povmark or Dare <br /> <br />E <br />b <br /> <br />