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1. Article Addressed to: <br />r4 <br />O <br />O <br />m <br />Postal Service <br />CERTIFIED RECEIPT <br />(Domestic Mail Only; No Insurance Coverage Provided) <br />,For delivery information visit our website at www.usps.com;, <br />0 <br />r4 <br />0 <br />I`- <br />• 2. Article Number <br />(Transfer from service label) <br />PS Form 3811, February 2004 <br />Postage <br />Certified Fee <br />Retum Receipt Fee <br />(Endorsement Required) <br />Restricted Delivery Fee <br />(Endorsement Required) <br />Total Postage & Fees <br />Sent To j l / `W t. <br />2 <br />Street, Apt. No.; <br />or PO Box No. ZZ� <br />City, State, ZIP+4 <br />LAvg_ <br />PS Form 3800. August.2006 <br />See Reverse tor Instructions <br />SENDER: COMPLETE THIS SECTION <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 />• Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />j v /6 <br />/ <br />z9 Lnif <br />Cpl Dot, <br />Signatu <br />Domestic Return Receipt <br />10/31/2011 <br />COMPLETE THIS SECTION ON DELIVERY <br />B. Received by ( Prince • Name) , e <br />3. Service Type <br />0 Certified Mail <br />0 Registered <br />0 Insured Mall <br />4. Restricted Delivery? (Extra Fee) <br />7010 3090 0001 8851 2333 <br />0 Agent <br />• <br />f !/ • It Addressee <br />b. Dat 'of elivery <br />D. Is delivery address different from item 1? 0 Yes <br />If YES, enter delivery address below: 0 No <br />0 Express Mail <br />0 Retum Receipt for Merchandise <br />0 C.O.D. <br />0 Yes <br />102595-02 -M -1540 <br />- —� <br />