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• 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� ❑ Agent <br />❑ Addre <br />9—,R7eived by (Print am e C. Date f Del <br />D. Is delivery address different from item 1'f ❑ s <br />If YES, enter delivery address below: 5ZNo <br />M -- Z0162 - 0/ F <br />3. Se a Type <br />Certified 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 7 010 1060 O D 01, 0936 7 818 <br />(Transfer from service label) <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />