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III II III III IIII III I <br />9 v •Comdde iienn t enNor z for eddleanel services. I also wish to receive fhe <br />w •Comdne iums s, ee, and Ib. folOwing services (for an <br />~ <br />~ •P(mt your none end addreaa on 1M roverse at this ban w Nat <br />rare to ycu. wa ran rerun this extra fee): <br />E <br />~ ./*rA nis roan to the hoe d iM rnsilpiece, «m tM berk it specs does na ~, ^ AddreSSee'S Address <br /> e~Rsrum AeaiptRpussred'on tM ma7Plece bebw Needide number Q,^Restrictod Delivery y <br />+b .11N RMUm Recelq vAll show to whom the ahidewaa tlNivarW <br />~'w•d• end the date <br />Consult postmaster for fee. <br /> <br />Y 3. Artlcle A <br />ddre <br />ssed to: 4a. Arfide Num er /~ <br />~ <br /> ~ <br />~ <br />~~ %~ltl/I l~ K ~N6 n `9 <br />~ <br />u //~r~ <br />~ n,1 ti n <br />~~ <br />C" <br />~n~' `-'`J <br />R <br />' <br />' 4b. Service Type <br />istered ^ Certified <br />^ Re <br /> ~~ <br />, <br />,~ <br />/ <br />1 u <br />r , l ` <br />I <br />,; /~ <br />~ /7~ n <br />e' <br />' L Lc g <br />^ Express Meil ^ Insured <br /> ~ <br />. <br />V <br />V 1, <br />~ ~ ^ ReNm Receipt for MercharMise 0 COD <br /> I ~ ~ • ~ 7 <br />D <br />t <br />f f <br />i L <br /> . <br />a <br />e o <br />~ <br />ery <br /> 5. Received By: (Print Name) 8. Addressee's Address (Onlyilrequested C <br /> and !ee !s paid) 'FF2 <br />8 6. srgnatu e: (addressee or alter <br />i. ~( <br />e <br />PS Fonn 3811, December 1994 <br />I <br />a <br />it <br />DIVISr~~ OF MINERALS AND <br />~.. <br />RECEIVED <br />'~ 23863 <br />.. ,gg3 <br />DATE ~-- <br />r <br />Cry/ <br />^ CASH <br />g~CfiECK <br />S3 _^ M.O. <br />FOR w"" <br />AMOUNT Of OUNT.... .......$ <br />AMOUNT PAID ... ... ... .....$ <br />Bp,LANCE DUE.. ..... ~ ~ ~$ <br />OU~ <br />BY <br />