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Permit# rn- i9~~,_ oaa MV- a,o~-O5 <br />Date: 9-~ = 0~ Recipients: ~~ i ~-f' L~; d-~ <br />TO:~zC~-L /~i~-c~~~c~ `L~~'a-~J`41'>~ROM: DRMS <br />LcYa~sffQ Cc~rri¢.rs ~Qu~-~ ~~• <br />Certpiz~ied Nail Receipt- ~~7", <br />^ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />^ Print your name and address on the reverse <br />so that we can return the card to you. <br />^ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressetl to: <br />Li~rty Mutual Insurance Company , <br />175 Berkeley St. <br />Boston, MA 02117 <br />A Signffiure/ <br />X ~ / ( Gt/ ^ Agent <br />C/ / v~l~ ^ Adtlressee <br />B. Received by (Panted Name) ~ C~Date of Delivery <br />D. Is delivery address tliHerent fmm item 19 ^ Yes <br />If YES, enter delivery address below: ^ No <br />3. Service Type <br />^ Certified Mail ^ Express Mall <br />^ Registered ^ Retum Receipt for Merchandise - <br />^ Insured Mail ^ C.O.D. <br />4. Restarted Delivery? (ExKe Fee) ^ yes <br />2. Article Number <br />(transfer from serv/ce labs 7 0 3 16 8 0 0 0 0 0 6 4 2 7 916 2 <br />PS Form 3811, February 2004 Domestic Return Receipt <br />102595-02-M-1540 <br />