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" SENDER: <br />v •Complete itema 1 anaor z ror additional eervi <br />I also wish to receive the <br />x .Complete items 3, 4e, and 4b. NI p.~~ <br />~ following services (for an <br />„ •Pdm your name arM address on the reverse of This y~ iha we can retullTnnn is extfa fea): <br />at <br />~ wrd to you. <br />•Aaach this form to the Irom of the mailpiece. or on the beck it space does not t , ^ Addre55ae'S Address ~ <br />Z <br />d <br />O permit. <br />• Writa'Relum geceipr gequesred' on the meilpiece below the article number. 2. ^ RBSfdCted DBlivery y <br />~ .The Retum Receipt will show l0 wTOm the artice was delivered antl the date <br />delivered. <br />Consult postmaster for fee. 6 <br />. <br />e ~ <br />a 3. Article Addressed to: 4a. Article Number u . <br />a ne ~Pke-r+ <br />C~r <br />~'1r ~ i ~ s~~ <br /> y <br />, T <br />b <br />S <br />i <br />E <br />o <br />v <br />n <br />Q~„'~ `r~C~ ~r/~/s <br /> <br />~h~ ype <br />4 <br />. <br />erv <br />ce <br />^ Registered ~Certifed <br />m <br /> <br />rn <br />w w~ <br />~~ ~ ~ ~ <br />~J ^ Express Mail ^ Insured 5 <br />m <br />' <br /> , ^ ReNm Receipt for Merchandise ^ COD <br />o ~~ <br />I.~yers <br />40103 7. Date Delive <br />r <br /> , <br />~ 5. Received ey: (Pdnf N B. A ressee's Address (OMy i/requested ~ <br />w and /ee is paid) i <br /> t- <br />g 6. Signatur (Addressee r ntJ <br />i. <br />a X <br />PS Form 3811, De~erdper t~sa' Domestic Return Receipt <br />