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SENDER: <br />v Compiei¢ Items 1 and/or Z for adaitionel services. I also wish t0 receive the <br />1e Complete items 3, end 4a & b. following SBrvices (for an extra tD <br />~ Print your name end address on the reverse of this form so t hat we can feel: a <br />C ,return this card to you. <br />m • Attach this form to the Iron[ of the marlpiece, ar on the beck it space 1. ^ Addressea•S Address i <br />N <br />does net permit. <br />' • Write "Return Receipt Repuestea" on the mailpiece below the a <br />« rticle number. <br />2. ^ Restricted Delivery d <br />• <br />• The Return Receipt will show to whom the article was delivered entl the dale ~ <br />o deiiverea. Consult ostmaster for fee. c <br />a 3. Article A <br />d <br />dressed to: 4a. Article Number <br />(r <br />~ <br />~~p <br />E ~• W ~I S ~ • S-~rzo~ T <br />4b <br />Servi <br />~ ~ ° <br /> ype <br />. <br />ce ~ <br />o C O <br />v <br />Q <br />~ ^ Registered ^ Insured ~ <br />y 1 ~ <br />' `,[~,Gerti}ied ^ COD .G <br />N <br />~tl $065 ~ <br />v I (le <br />P A~ ^ Express Mail ^ Return Receipt for <br />Merchandise ~ <br />., <br />. <br />G ~ <br />C 7. Date of Deliverry <br />4 . ~ <br />`` <br />Q . <br />. i.. <br />J G <br />Z <br />5. Signature (Addressee) <br />8. Addressee's Address (Only if requested T <br />y <br />F and fee is paid) y <br />¢ Si a e (Agent) _ T <br /> <br />rAS 77, ace bar 7s97 3 U.S.G.P. .:1992-3o7-53D DOMESTIC RETURN RE FT <br />