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C.-SENDER: I also wish to receive the <br /> a ■Complete items 1 and/or 2 for additional services. following Services(for an <br /> w ■Complete items'3,4a,and 4b. <br /> a) ■Print your name and address on the reverse of this form so that we can return this extra fee): <br /> card to you. <br /> Attach this form to the front of the mailpiece,or on the back if space does not 1.❑ Addressee's Address v <br /> y permit. 2.❑ Restricted Delivery 4) <br /> ■Write"Return Receipt Requested"on the mailplece below the article number. ry y , <br /> Y e The Return Receipt will show to whom the article was delivered and the date Consult postmaster for fee. c <br /> delivered. <br /> o 3.Article Addressed to: 4a.Article Number <br /> -� !tom Y z <br /> Pgw 4b.Service Type <br /> 0 ❑ Registered [ Certified p" <br /> D 73 5 z/�! L <br /> U <br /> ❑ OlExpress Mail Insured e <br /> Cn <br /> W t / eturn Receipt for Merch ndise COD <br /> p <br /> G <br /> a o <br /> cc 5. Received By: (Pfir t Name) 8.A s s(O ly i requeste Y <br /> --�• c ' <br /> and fLY <br /> � <br /> 6. ignat . (Addr see or Agent) ~ <br /> >. <br /> PS Fo 3811,December 1994 102595-98-13-0229 Domestic Return Receipt <br /> Z 442 198 931 <br /> US Postal Service <br /> Receipt for Certified Mail <br /> No Insurance Coverage Provided. <br /> Do not use for International Mail See reverse <br /> Sent to „n / t r, m <br /> Street&NLut-mbeer 1,/y({� <br /> Post ice,Sta ,&ZIP 16``/ <br /> Postage $ G L <br /> Certified Fee O <br /> Special Delivery Fee <br /> Restricted Delivery Fee <br /> LO <br /> Return Receipt Showing to <br /> Whom&Date Delivered_, r t <br /> 8. Return Receipt S -�'*°% <br /> Q Date,&AddrelBee'sAddres <br /> O TOTAL Postage&Fe� $ <br /> ap tcc _ <br /> EPostm" =dr <br /> u- <br /> (n % <br /> �� � . <br />