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U.S. Postal Service, <br />CERTIFIED MAIL,., RECEIPT <br />(Domestic Mail Only; No Insurance, Coverage Provided) <br />For delivery information "'mot• <br />(Ends <br />Restricted Delivery Fee <br />(Endorsement Required) <br />Total Postage & Fees <br />Sent To <br />Street, Apt. No.; p <br />or PO Box No. l { Z� 16 Q ) & �Ot.�(1�, <br />City, State, ZIP +4 <br />ioeavl Go Ibt 0 <br />See Reverse for Instructions <br />m SENDER: <br />o ■ Complete items 1 and/or 2 for additional services. <br />et <br />•Complete items 3, 4a, and 4b. <br />rn ■ Print your name and address on the reverse of this form so that we can retum this <br />card to you. <br />■ Attach this form to the front of the mailpiece, or on the back if space does not <br />permit. <br />• ■ Write'Return Receipt Requested' on the mailpiece below the article number. <br />•The Retum Receipt will show to whom the article was delivered and the date <br />• delivered. <br />O <br />d 3. Article Addressed to: <br />a K� i G tt k <br />° <br />✓ 4 31(O 69 01 X41 �Octa a -2\ <br />co <br />cc , 'ZaltveA VI / G 0 1.0103 <br />ra <br />ea <br />z J�/ /ex is S S<a/eid <br />c. • 5. R i By tint Name) <br />cc W 5//7 <br />g 6. Signatur (Addressee orAgen <br />0 <br />X <br />N <br />Postage: <br />Certified Fee: <br />Return Receipt Fee: <br />Total Postage & Fees: <br />PS Form 3811, December 1994 <br />$1.48 <br />$2.85 <br />$2.30 <br />$6.63 <br />Mere <br />7009 <br />Y <br />• M- <br />ST.tl <br />l -i1 <br />CsAi. <br />I also wish to receive the <br />following services (for an <br />extra fee): <br />1. ❑ Addressee's Address <br />2. ❑ Restricted Delivery <br />Consult postmaster for fee. <br />4b. Serv' _ e <br />❑ egistered X Certified <br />■ Express Mail ❑ Insured <br />7. � e rr}Receipt for Me and ;• : ❑ COD <br />3te c4f taIitnr <br />8. ddressee's Ad • - s ( •- ly if requested <br />a =e is• <br />Hl�9d� <br />Domestic Return Receipt <br />4eid Vwt,t <br />7 <br />JJMS <br />3 5701 1315 <br />