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- ~ ~ ~ ~ • u SENDER: I also wish to receive the <br />v <br />m • Complete dams 1 anNOr 2 for additional services. <br />.Complete items 3, 4a, end 4b. follOwin services for an <br />g t <br />b • Pnnt your name antl atldress On the reverse or this loan 50 that <br />card to you we can return Ihis extra fee): <br />t <br />~ • Adach Ihis loan Io Iha Iron) of the mailpiece, or on the back it space does not 1. ^ Addressee's Address - <br />m permit. <br />• Wnte 'Relum Receipt Requested'on the mailpiece below the aniUe numb¢r 2. ^ Restricted Delivery <br />~ <br /> • The flelum Receipt will show to whom the adicle was delivered <br />deiiverea and the dale <br />Consult postmaster for fee. <br />~ <br /> <br />o <br />:: 3. Article Addressed to: ~ /J <br /> <br />~/^~ <br />OJL/J <br />~ <br />C~~ '~ 4a. Artt a N~y~/nb r/ _ / _F <br />Oc~llJ~r~ ~J (JD f <br />n <br />o <br />u ~ <br />~~~~~ ~~ 4b. Service Type 1 ~ <br />^ Registered L4i Certdied <br />~ <br />S <br /> <br /> <br />~~~~~~ <br />~ ~~Q ~ L <br />1 <br />^ Express Mail Insured <br />^ Return Receipt for Merchandise ^ COD <br />~ <br /> / 7. Date o; Delive <br />i ~'~ ; <br /> ~ i i <br /> 5. Received By: (Pont Name) B. Ad ressee' Address (Only t requested <br /> and lee is paid) l <br /> <br />6. Signature: (Addressee rAgent) / l <br />F <br />r X. ~ 1 ~ <br />`" Rs Form 811, camber tssa 102595-98 B 0229 Domestic Return Receipt <br />