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¦ Complete items 1, 2, and 3. Also complete A. Signature <br />item 4 if Restricted Delivery is desired. ? Agent <br />¦ Print your name and address on the reverse X ? Addressee <br />so that we can return the card to you. B. Received by (Printed Name) C. Date of Delivery <br />¦ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />D. Is delivery address different from item 1 ? ? Yes <br />If YES, enter delivery address below: ? No <br />3. Service Type <br />,E9.1?ertified Mail ? Express Mail' <br />? Registered Return Receipt for Merchandise <br />? Insured Mail ? C.O.D. <br />4. Restricted Delivery? (Extra Fee) ? Yes <br />2. Article Number <br />(Transfer from service label) /(j'nl? <br />PS Form 381 1 , February 2004 f Domestic Return [Receipt I ( L 102595-02-M-1540 <br />r--q <br />IT' <br />O <br />p <br />.D <br />r-? <br />-? O <br />O <br />O <br />t:J <br />M <br />CO <br />O <br />O <br />(ti <br />r-3 <br /> I . I <br /> <br /> <br /> <br /> <br />o C7 <br />.0 -D Postage $ <br /> .-0 <br /> <br />r-9 <br />r-q Certified Fee <br />p <br /> <br />O p <br /> <br />O <br />Return Receipt Fee <br />(Endorsement Required) Postmark <br />Here <br />O O <br /> Restricted Delivery Fee <br /> (Endorsement Required) <br /> <br />f•rl M Total Postage & Fees <br />a ra <br />cc <br />?o O CO <br />CD Sent To `` ri <br />l <br />e- ,r <br /> <br />O <br />O ....... <br />Street, Apt. No.: n <br />....... <br />or PO Box No. P,r•?/ 17, <br />C <br /> <br />State, ZIP+4 <br />ifY,I? <br />:.. M. _. _..._...\_...... ............................... <br />r-. <br />dD8 <br /> <br />w