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R-1 <br />Amendment to Application Notices Mailed 10/19/05 <br /> <br />^ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Detivery 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 Addressed to: <br />~y{~t_ ~ 1eJrt5~ ~u-i~ff`Fr52/t <br />c~ t~3 /a-i T po r i- 12C~ . <br />=urea-t c <br />A Signature ~ <br />X(, ~~ ~ <br />B. Receivetl by (Piloted Name) C. <br />D. Is tlelNery address differem from item 7~ ~Jre; <br />RYES, errter delivery adtlress below: ~f No <br />9 V r ~ 3. Service Type <br />~ 13G3 Certified Mail ^ Express Mali <br />^ Registered ^ Retum Receipt for Merchandise <br />^ Insured Mail ^ C.O.D. <br />" 4. ResMCted Delivery? (Extra Fee) ^ Yes <br />2. ANcleNumber 7Q03 1010 0004 2435 9630 <br />(rmnsler from serv/ce laben <br />PS Form 3811, August 2001 Domestic Retum Receipt tozsssoz-M-tsno <br />^ Complete items 1, 2, and 3. Also complete <br />Rem 4 if Restricted Delivery is desired. <br />^ Print your name and address on the reverse <br />so that we can etum the card to you. <br />^ Attach this card to the back of the mailpiers, <br />~ or on Ne front R space pernks. <br />1. ANCIe Addressed-to: <br />Lem S ~Lor-rc` ,~1~-o~c5-~ <br />a-~ 9 g ~~~~-r~.Lc~ T2 <br />A Sign ure <br />X ^ Agent <br />""°~•. ~ ' ^ Addressee <br />. ReceNed by (Filmed Name) C. Date of Delivery " <br />; <br />D. Is delivery address dM I~srn ^ Yea 1 <br />RYES, enter delivery ~ No <br />~j\IQZ' ~.y ` <br />bZ -: ~ I( <br />1~/ Wit" (9~T 1 c/ N l ~ ' 3. SeMCe TYPe ~° 1w e~F)~ <br />I ~j ~.y! CartRied Mall ^~F~g7l9ee~,ld1~ <br />~`~~~ ~Resgu Mail ^Cetum Receipt for Merchandise <br />4. Restricted Detivery? (EzVa Fee) ^ yeg <br />z. Article Number ~" 7003 11721] OQ[]4 2435 9654 <br />Ps Form 3811; August goof Domestic Retum Receipt <br />