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d SENDER: <br />t7 ■ Complete items 1 and/or 2 for additional services. <br />om •Complete items 3, 4a, and 4b. <br />• ■ Print your name and address on the reverse of this form so that we can retum this <br />E card to you. <br />j •Attach this form to the front of the mailpiece, or on the back if space does not' <br />` permit. <br />at ■ Write'Retum 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 />c delivered. <br />O <br />d 3. Article Addressed to: <br />ILIAC vWLV\ <br />8 <br />k='o. Qex 5g\ <br />ye &1 d° g1,064 <br />5. Received By: (Print blame) <br />W'. <br />cc <br />C <br />G <br />Q <br />cc <br />cc D <br />WA. <br />g 6. Sig re: (Addressee or Agent) <br />> X <br />T <br />▪ PS Form 3811, December 1994 <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 />_ I ,ta Ortirla N 'mbar <br />7009 2820 0003 5701 0387 <br />4b. Service Type <br />❑ Registered NI Certified <br />❑ Express Mail ❑ Insured <br />❑ Retum Receipt for Merchandise ❑ COD <br />7. Date of Delivery <br />F it <br />8. Addressee's Address (Only if requested <br />and fee is paid) <br />Domestic Return Receipt <br />• M- zoi/ - 039 <br />• ,-. 15-/(. <br />eg <br />4 : 16 ) <br />it4a1a/n <br />¢o . D RrN S <br />