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• SENDER: Complete items 1 and 2 when edditlonel strviees ero sNSirod, end complete (tams 3 end d <br />Put Your address in the "RETURN TO" spec( on the reYergsidt. Failuro to do this will prevent this <br />from (king returned to yW.'Ihe return_rtteipt (ee will ptpvidfiYou the name of the person ; <br />i retltpandthedateofdetWe Oradtldiane feestpe olip'CI'itngetrvlce:~er -evaNapT,cenv' <br />tmp r ar ees and c ec c ox es1 for additippaf Yer!!leels) requested. ~; <br />SRf1pYr 4dvthom delivered. date: andlddr¢s5ee sadd[ess. T. ©RenriotadF]aLtarv,: ..~: <br />ti~cy1~8 AddrKfed f0: <br />1933 ~'.Il~~+~~-' <br />Gr cf~ 8v~31 <br />rllYe')CP. - AddrN53PP n <br />x `~( <br />6. Signature -Agent <br />X <br />7. Date of Delivery OCT 2 g <br />1987 <br />5 Form 3Bi1,. <br />r. <br />Reglsstt~~red Insured '" <br />Cert'fied COQ <br />ExProeJ Meil <br />Always obtain signature of addressee or <br />anent end DATE DELIVERED. <br />requested and jee paid/ <br />~~~~~`~ CO~~~ t <br />P 051 8.74'672" <br />RECEIPF FOR CERTIFIED MAIL <br />NO INSURANCE COVERAGE PROVIDED <br />NOT FOR INTERNATIONAL MAIL <br />(See Reve _0 ~ <br />° Sant to ' <br />o ~~ <br />r <br />Street an No. <br />m° <br />P.O., Stal antl ZIP Code I <br />O <br />d <br />O Postage s <br />vi _ j <br />~ - e 1 <br />-i <br />Special Deliv my e ~ ~ I <br />Restrictetl Delivery Fee <br />I' <br />[p ~•••• •.. y. anawu RTI6 <br />m Date, and Adtlre of Deliver <br />•- ~!~ <br />m TOTAL Po51a rynr'~ees <br />LL ~ ,a <br />Postmark or _ ~e <br />~ "v C~ <br />E ' Y rt .. <br />LL ~..~ `.~-OJ ~' <br />y .- , i <br />a <br />