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LINI'TED STnTrs P~/u. SE ~ ""`. ~ ,~~~ f~','-"~~ ~ ~ ~~ <br />v, <br />~... . ~ . ' ~ ~ ,' I h ~ I-^~ ~. ~~~3`-^ ~. ,rQrftltt4~Q~}e <br />• Print your ttte: ` res_4_/anrl ~`rri~ r.,,~'~.,••` ~.,~•~•• <br />1~Jrn. cS V~an~Va~dC4,,~,~",~7 <br />1a3s3 ~Fu,~,) icy <br />~.ads~~ c~ Fsa~a ~ <br />%1+~Q.:~•~.+'7~~ ~~rrlil~~rrri~~~ri',~~~:~I~r,r/,ri~~I~J,r~-~-~u/trt-~r~~ri'r~,rr'r.~~~ <br />d SENDER: <br />'0 <br />~ ^Complete items tand/or 2 for additional services. <br />^Complete items 3 <br />aa <br />andab I also WISh t0 reC81V8 the <br /> <br />at , <br />, <br />. <br />^ Print your name and address on the reverse of this form so that we can return this <br />card to you. ,: following services (for an <br /> <br />extra fee): <br />~ <br />~ ^Attach this form to the front of the mailpiece, or on the back if space does not <br />Permit: ~ , ^ Addressee's Address ~ ~ <br />'m ^ Write Return Receipt Requested' on the mailpiece below the article.number. <br />^The Return Receiprwill show to whom the artide was delivered and the date <br />2• ^ Restricted Delivery d <br />rn <br />c <br />o delivered. <br />Consult postmaster for fee. ~ <br /> <br />• <br />~ 3. Article Addressed to: <br />~ ~' <br />d <br />r ""`~' 704 2510 ~~02 9733 674 <br />c <br />• ° <br />a a ~ ~ w , W # 4b. Senrice T e <br />^ Registered Certified ~ <br />~ <br />w <br />. ( ~ <br />~~~ ~l ~S ~' ^ Express Mail ^ Insured <br /> <br />^ <br />~' <br />~ ~ Return Recei t for Merchandise ^ COD <br />P <br />• a t <br />~~~ a 7. Date of D ry ~`- ,o <br /> <br />~ ~~ <br />r ~ <br />~ <br /> 5. Received By: (Print Name) 8. Addressee's Address ( my if requested '° <br />w /V A ~~ ~ per/ and lee is paid) t <br />c 6. Signature: (Addressee or Agent) E- <br /> X CG-~~u~ X11 ~r~.~-~~ <br />PS f=orm 3811, December 1994 ,ozsse-s~-a-o,~s Domestic Return Receipt <br />