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SENDER: COMPLETE THIS SECTION <br />COMPLETE THIS SECTION ON DELIVERY <br />B. Received by ' " rtnted Name) <br />RUBY CRUZ <br />A. Signatu <br />x <br />❑ Agent <br />❑ Addressee <br />• Complete items 1, 2, and 3. Also complete <br />item 4 If Restricted Delivery Is desired. <br />• Print your name and address on the reverse <br />so that we can return the card to you. <br />is Attach this card to the back of the mailpiece, <br />or on the front If space permits. <br />1. Article Addressed to: <br />Washington International Insurance Company <br />475 N. Martingale Road, Suite 850 <br />Schaumburg, Illinois 60173 <br />2. Article Number <br />(Transfer from service label) <br />PS Form 3811, February 2004 <br />7009 2820 0003 5700 8469 <br />3. Service Type <br />❑ Certified Mail <br />❑ Registered <br />❑ Insured Mail <br />Domestic Return Receipt <br />C. Date of Delivery <br />D. Is delivery address different from Item 1? o (No <br />If YES, enter delivery address below: <br />4. Restricted Delivery? (Extra Fee) <br />;1(' Fri 4), - to a. <br />corce <br />❑ Express Mail <br />❑ Return Receipt for Merchandise <br />❑ C.O.D. <br />❑ Yes <br />10595 -02 -M -1540 <br />