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Postal <br />CERTIFIED MAIL,. RECEIPT <br />rrl (Domestic Mail Only; No Insurance Coverage Provided) <br />O <br />..n 1 <br />r" ?' <br />_r $1.56 0127 <br />?- Postage <br />cc <br />cardfled Fee $2.80 08 <br />C3 Postmark <br />E3 Return Receipt Fee $2.30 Her !R <br />O (Endorsement Required) ` ?, <br />Restricted Delivery Fee <br />(Endo rsementRequired) ?•? ?? <br />O Total Postage & Fees $ $6.66 12/1712010 <br />r_9 <br />C Sent To <br />3 Street, Apt No.; <br />or PO Box No. 4!? ,F`-?T ----------- <br />Qty State, ZIPr4 CO ¦ Complete items 1, 2, and 3. Also complete A. Signature <br />Item 4 If Restricted Delivery Is desired. X <br />¦ Print your name and address on the reverse <br />so that we can return the card to you. B. Re <br />¦ Attach thiscard to the back of the mailpiece, <br />or on the front if space permits. <br /> <br />1. Article Addressed to: <br />? Agent <br />? Addressee <br />C. Date of Delivery <br />D. Is delivery ddress different from item 1? ? Yes <br />If YES, enter delivery address below: ? No <br />3. Service 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 />2. Article Nl 7010 1060 0000 8447 6703 <br />(Transfer <br />Ps Form 3811, February 2004 Domestic Return Receipt 102595-02-wt-1540