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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 />A. Sig ture < <br />J�•�• —, 13 Agent <br />X ❑ Addressee <br />v by (. nted Name) <br />1 �� <br />C. Date of Delivery <br />� _ �ZC�I Z <br />so that we can return the card to you. <br />• Attach this card to the back of the mail piece, <br />or on the front if space permits. p <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, tinter delivery address below: ❑ No <br />1. Article Addressed to: <br />3. Service Type <br />❑ Certified Mail ❑ Express Mail <br />(}�� /►� <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 5701 3982 <br />(Transfer from service lab <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />/Z <br />dr:))ayi"/ I,�a <br />vP < rCP <br />j"VOC, <br />