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- Rt <br /> ��x I <br /> fi <br /> J 4Wry {r <br /> l - <br /> t r:... - <br /> F 720 678 552 <br /> RECEIPT FOR CERTIFIED MAIL <br /> NO INSURANCE COVERAGE PROVIDED <br /> NOT FOR INTERNATIONAL MAIL <br /> (See Reverse) <br /> Sent to <br /> Sire and U0. <br /> 0•! Z S <br /> P.O., to and ZIP Code <br /> ✓fw1444lta Co ToyJ-5i <br /> Postage <br /> S 37 <br /> Certified Fee <br /> 16 <br /> Special Delivery Fee <br /> Restricted Delivery Fee <br /> Return Receipt showing <br /> to whom and Date Delivered /.r-0 <br /> 0 Return Receipt showing to whom. <br /> Date,and Address of Delivery <br /> m <br /> TOTAL Postage and Fees s <br /> Postm — <br /> m SENDER: <br /> i 13 ■Complete items t and/or 2 for additional services. I also wish to receive the <br /> 0 ■Complete items 3,4a,and 4b. following services(for an <br /> -Print your name and address on the reverse of this torn so that we can return this extfd fee)' <br /> at card to you. . <br /> 1 > -Attach this form to the front of the mailpiece,or on the back ir space does not, j•0 Addressee's <br /> ID ■ Address <br /> W Retum Receipt Requested,on the mailpiece below the amide number. o <br /> 1 $ -The Return Receipt will show to whom the article was delivered and the date 2 Restricted Delivery N <br /> Ic delivered. <br /> o Consult postmaster for fee. � <br /> -a 3.Article Addressed to: 4a.Article Number <br /> �5z <br /> E <br /> �iqy 1 o �yrd�((,, /( 54D 4b.Service Type <br /> j n ❑ Registered 9(Certifted W: <br /> /"" • / `' ❑ ExprMail ❑ Insured 5 <br /> ov <br /> ❑ Return Receipt for MerChartdse ❑ COD i <br /> 5 7.Date of esive <br /> OO'Ik o i i c <br /> S.Received By:(Print Name) 8.Addre ee's Address(Only if req es <br /> and tee is paid) W; <br /> g 6.Sign ture:(Add a or Agent) <br /> Xf <br /> PS Form 3811, December 1934 DOMP.Ctir` Rot,irn om.. ;. <br />