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• SENDER: <br />v •Complete items 1 and/or 2 for additional services. <br />rn <br />•Complete items 3, 4a, and 4b. <br />H ■ Print your name and address on the reverse of this form so that we can retum this <br />rz card to you. <br />• • •Attach this form to the front of the mailpiece, or on the back if space does not <br />d permit. <br />• ■ Write'Retum Receipt Requested' on the mailpiece below the article number. <br />6 •The Retum Receipt will show to whom the article was delivered and the date <br />• delivered. <br />0 <br />v 3. Article Addressed to: <br />15 <br />d 5104 C110.(1/A <br />o <br />n Wl 5 Q Cero5 -4 Li1. <br />cc w <br />ca <br />i fox 5ZA <br />cl <br />cc <br />• 5. Received By: (Print Name) <br />W <br />Q <br />g 6. Sig atu ` ddr�° or Agent) <br />� X� <br />PS Form 3811, D: e er 1894 <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 />7009 2820 0003 5701 0356 <br />4b. Service Type <br />❑ Registered <br />❑ Express Mail <br />❑ Retum Receipt for Merchandise ❑ COD <br />7. Date of Delivery <br />l Certified <br />❑ Insured <br />8. Addressee's Address (Only if requested <br />and fee is paid) <br />Domestic Return Receipt <br />•M - 2.00‘-0/0 <br />1)15 <br />-10 <br />