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$ SENDER: <br />• Comp1e16lremc t anew 2 br eddlfbnat oeMma. <br />~ 1 Wso wish to receNe the <br />following services (tor en <br />.Complain iternc 3, ~a. cM ~. <br />ggg • Pnm your name end adaca~ on Vte reveres d th4 form w that tw ran reNm hb <br />caN b <br />ou <br />eldre fee): - <br /> <br />8 <br />. <br />y <br />+patt does na <br />. Atlndi Nis rom, to aye 1ron1 d ttb mellplece, « on br back d t. O Addressee's Address <br />~ <br />p¢°n'+' <br />• Write 'Refum Receipt FleWrsfsJ' «r the mellpiece baba me eNtle number. <br />2. ~ Restricted Delive <br />ry t <br />• The Retum Receipt vUl chow to rm«n Uie snide v.u delNarad entl the date <br />tlellveretl. C.OrISUtt pOSlmaSter for }BB. '~ <br />o Arti^cle Ad'dre(~ss pro: <br />~~ <br />~ <br />~S rt' Ip ~mp~r ^ ~ 7 <br />l-' Il 1-11 C--VI <br />-~-' <br />k <br />r' <br />1..~-~ <br />y <br />$ ~ ? (~ -O'*C <br />~ <br />~ ~ 4b. Ss rvia Type \J <br />O Re gistered ~~erlified <br />s <br /> <br />A' C.~- <br />~~~~~~ ~ ^ Er.press Mail Insuretl <br />^ W:tum Receipt fa bler~handise ^ GOD ~ <br />~ <br /> <br /> 7. De.te of Delivery <br /> O _. ~ <br /> 5. Received By: (Pdn} Hama ff. A~idresseo's Address (Only if requegted <br />aid lee is paid) <br />9g° <br /> <br /> <br />^ PS Fonn 3811(DkcerpfSer t99d to2ses-aeeoa2e <br />Spy <br />~ Z 4 3 4 9 41F~f~8 I~ ,~/ <br />~S Postal Service ~ [ ~/~~Q <br />flReceip'~for Certified Mat T <br />..No ItSsurance Coverage Provided. <br />[~.. ....f ~~ a r... Inmmafinnet Mlai /Coo ravarsal <br /> <br /> <br />ti r ~• ~• <br />3 <br />w 051 Di(I f0. 1 <br />~ <br /> Pastapa 4 <br /> CeNf{ed Fee Y+ <br />v, ~ '~ <br /> Spedal Delivery Fee <br />• Restncted Delivery Fee <br /> <br />= Relum Receipt Showing tp <br />Whom 6 Date Delivered <br />Z `-1'- <br /> ReormR~Showig roWhnn, <br />Dale, a Mdressees A4arass <br /> TOTAL Postage 8 Feas ~ C. , ~ O <br /> Postmark or Dale <br />