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d SENDER: I also wish to receive the <br />d <br />.y • ComDlme items 1 antllor 2 for atldihonal services. (OIOwing services (fnr aR <br /> <br />d • Complete clams 3. 4a, antl 4b. <br />• Pnnl your name and address on the reverse of Ihis form so Thal we can return Ih <br />is <br />extra fee}: <br />m <br />~ card to ou. <br />• Attach this form ro the Irons of the mailpiece, or on the back d space tloes not <br />1. ^ Addressee's Address ~ <br />•~ <br />m permit. <br />• Wnle 'Realm Receipt ReQuesletl' on the mailpiece below pie snide rwmbec <br />2. ^ RBSlrlcted Delivery <br />y <br />N • The Realm Receipt will show 10 whom the dtlaae was delrveretl antl the tlale <br />Consul) postmaster for fee. <br />n <br /> delrverea. <br />0 3. Art <br />i <br />c <br />l <br />e Addressetl to: 4a. Anicle Number <br /> t <br />- <br />v <br />~ .y <br />~ <br />a <br />ti <br />L` ` ~ ~ J <br />4b. rvice Type c <br />~ <br />o ~~.~ ~ °° v ( p ^ Registered ~Cenified <br />u <br />/~ 1 <br />d~ ~ <br />(l P ~ <br />^ Express Mail ^ Insured <br />~ <br /> ` <br />• ^ Return Receipt for Merchandise ^ COD ~ <br /> Y !1 ~ ~~~~ <br />p <br />p Y_Li„ 7. Date of Delivery Qua <br />g z o <br /> A <br />1 o o <br /> 5. eceived By: (Print Name) 8. Addressee's Address (Only it requested x <br /> and fee is paid) ~ <br />m <br /> L <br /> 6. Si ur : ddres$ee or Ag n ~ <br />~ <br />0 <br />T ~ <br />1 <br />`-' PS Form 1, December 799a 10259598-e-0229 Domestic Return Receipt C <br />~ <br />`^~ ~O ~~ <br />~ <br />P 436 785 349 <br /> <br />t <br />c~ <br />0 US P slat Service <br />0 <br />Receip~ for-C'ertified-Mail <br />No Insurance Coverage?rovided. <br />Do not use for International Mail S e rave <br />,~ Sem to Lv~"t'l c <br />K Mn 5 o t <br />17 <br />s 51 a 4 Numbe~0 ~ ~ (~ <br /> P f^ ce, le, 8 ZIP e <br />A Pa ge _ 3 <br />V Cettilled Fee ~ ' CO , c.i.~ <br />G <br />= <br />Spetlal Del ~ ee o <br />N <br /> Resaiaed Fee ~ <br /> <br />om Return Rec <br />N <br />- Whom 8 Date fed $Q i ~ Z.s <br />AC Rehm Reayt Slpwilpm <br />a Dare,BPddresseas Mhes <br /> TOTAL Postage 6 Fees $ ~ .~{$ <br /> Pasanalk or Date <br /> (O <br />T ~ <br />~I <br />t <br />(1 <br />