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°M -l9'77- <br />y /l9l 2 <br />/4�t <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 />1. Article Addressed to: <br />A. <br />❑ Agent <br />❑ Addressee <br />(Pripted Name) C. Date'pf Deliv y <br />D. Is delivery address different from Item 17' ❑ Y€' <br />If YES, enter delivery address below: ❑ No <br />del � co ps a: -- 3. Servjpe Type <br />lirCertifled Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7009 2820 0003 5700 8056 <br />(iFansfer from service label) <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />