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Z XXW S <br /> <br />¦ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />¦ Print your name and address on the reverse <br />so that we can return the card to you. <br />¦ Attach this card to the back of the mailplece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />010"1 S Nc k to <br />2. Article Number <br />(Transfer from service label) <br />A. Signa <br />X E3 Agent <br />? Addressee . <br />B. Received by (Pii?n?t"ed Name) C. Date of Delivery <br />-ft(tO l? ASFOf A-4-aC, <br />D. Is delivery address different from item 1? ? Yes -? <br />If YES, enter delivery address below: ? No <br />3. Serv'ee Type <br />Certified Mail ? Express Mail <br />? Registered ? Return Receipt for Merchandise <br />? Insured Mail ? C.O.D. <br />4. Restricted Delivery? (Extra Fee) ? Yes <br />7008 1140 0003 4437 3919 <br />Y_ <br />PS Form 3511 February 2004 <br />Domestic Return Receipt 102595-02-M-1t- <br />1z" maw, <br /> Do <br /> <br /> <br />r- Postage: $0 <br />44 <br /> <br />M <br /> <br />Certified Fee: . <br />- <br />$2,80 <br /> Return Receipt Fee: $2 <br />30 <br />M Cer . <br />° <br /> <br />O Return Re Total Postage & Fees: <br />(Endorsement i x$ <br />5.54 <br />C3 Restricted DeliveryFee <br />(Endorsement Required) ?? - <br />C3 <br />r-j Total Postage & Fees $ <br />r-a <br /> <br />CO Sent To <br /> <br />\- <br />? <br />O -°--? .... <br />Street Apt. No.: <br />or PO Box No. R <br />C) <br />C ' ..........._...° <br /> - <br />City, State. ZlP+4 ?.? ------°------ ------ <br />T-- <br />? <br />17 ------------------------ <br /> • o16 a?