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SENDER: COMPLETE THIS SECTION <br />COMPLETE THIS SECTION ON DELIVERY <br />B. Received by (Printed Name) <br />C. Date of Delivery <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 />� �l,o,r�o <br />O.,,, vutN <br />3 c F03 <br />2. Article Number <br />(Transfer from service label) <br />PS Form 3811, February 2004 <br />A. Signature <br />X <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />Itzteir i - f <br />3. Servici Type <br />W rtlfied Mail <br />❑ Registered <br />❑ Insured Mail <br />4. Restricted Delivery? (Extra Fee) <br />❑ Express Mail <br />❑ Return Receipt for Merchandise <br />❑ C.O.D. <br />7010 1060 0001 0936 8365 <br />❑ Yes <br />Domestic Return Receipt 102595 -02 -M -1540 <br />‘ 198i- 5'2 <br />❑ Agent <br />❑ Addressee <br />