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• Complete Items -1 , 2, and 3. Also complete <br />item 4 it Restricted Delivery is desired. <br />® Print your name and address on the reverse <br />so that we can return the card to you. <br />al Attach this care to the back of the mailpiece, <br />or on the front if space permit. <br />1 . Article Addressed to: <br />; _ <br />A Signature <br />/ _ i ❑ Agent <br />- .':(» - 1' i� l f iii it Addressee <br />B. Received by j,Pnnted Name) C. Date of Del ivery <br />D. Is delivery address &frmwrt from kern 1? E Yes <br />If YES, enter aellvery address below: 0 No <br />3. Service Type <br />❑ Certified Mail <br />Registered <br />❑ Insured Mad <br />4. Restricted Delivery? (Extra Fee) <br />2. Article Number- <br />?Transfer from service label) - 1 ' <br />PS Form 3811, February 2004 Domestic Return Receipt <br />SENDER: COMPLETE THIS SECTION <br />m Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />m Print your name and address on the reverse <br />so that we can return the card to you <br />la Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />t article Acidressud to- <br />r <br />2. Artcle NumPer <br />(Transfer from service label) <br />COMPLETE THIS SECTION ON DELIVERY <br />A. Signature <br />X. <br />B. Received by (Printed Name) <br />1 0 is delivery address different front item 1? ❑ Yes <br />It YES, enter delivery address below ❑ No <br />3. Service Type <br />0 Certified Mail <br />0 Registered <br />❑ insured Mad <br />I 4 Restricted Delivey? (Extra Fee) <br />:LT.:, r r <br />PS Form 3811, February 2004 Domestic Return Receipt <br />❑ Express Mail <br />0 Return Receipt for Merchandise <br />❑ C.O.D. <br />❑ Yes <br />1025.95 - 02 - M <br />❑ Agent <br />0 Addressee <br />1 c. Date of Delivery <br />❑ Express Mail <br />C Return Receipt for Merchandise <br />o C.O.D. <br />❑ Yes <br />102595- 02- M•1540 <br />