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<br /> <br />9 SENDER: " <br />•Complete ileme 1 enNor 2 for additional services. <br />I a150 WISh f0 reC01Ve the <br />Ip •Campete items 3, 4a, and 46. fOIIOWIng eervICBS (fOf an <br />m • Prins your name end address on Ne rerene of this form so that we can return this extra fee <br />~ <br />i <br />j <br />m U!d 10 YOU. <br />•Aaach this lonn to the front of the mailpiece, or on the back it space does not t, ^ Addre556e~5 AddreSS • <br />~ <br /> • Wn el'Refum Racer R uesled' on the mail iece below the snide number. <br />2. ^ Restricted Delivery ~ <br />N <br />~ •The Return Receiptt volt Show to whom the ert'ide was deliveretl end the date <br />delivered. Consult postmaster for fee. ~ <br />O a1 <br />v 3. Article Addressed to: 4a. Article Number u <br />d ~c~ Ct eeV. ~~~~ ~ 5.2.00 ~ $ I '749 <br />E <br />° / <br />,~~a ~ <br />' <br />~" ~ ~ <br />~ 4b. Service Type «'~ <br />u ' <br />' <br />` ^ Registered ~rtifed <br /> <br /> <br /> <br />~ ~) Op~ <br />wC <br />^ Express Mail ^ Insured rn <br /> <br />m <br /> / ^ Return Receipt for Merchandise ^ COD <br /> 7. Date of Delivery <br />2 T <br /> 5. Received By: Prin Name) 6. Addressee's Address (Only it requested ~ <br />w r~ and lee is paid) t <br /> F- <br />g <br />T 6. SXnature: (Ad ress~ o ggent) <br />U , <br />/ <br /> ~/ <br /> PS Form 3811, December 1994 Domestic Return Receipt <br />~ 526 431 749 <br />v <br />P Service <br />e ipt for Certified. Mail ~ <br />NyDSUrance Coverage Provided. i <br />knot use fa International Mail (See reverse)W <br />S <br />Fea <br />Dalirery <br />TOTAL Postage 8 Fees <br />PosMerk or Date <br />li <br />