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SENDER: <br /> V ■Complete items 1 and/or 2 for additional services. I also wish to receive the <br /> ■Complete items 3,4a,and 4b. following services(for an <br /> G) •Print your name and address on the reverse of this form so that we can return this extra fee): <br /> card to you. <br /> j ■Attach this form to the front of the mailpiece,or on the back if space does not permit. �, ❑ Addressee's Address <br /> d Z <br /> m ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2, ❑ Restricted Delivery <br /> to ■The Return Receipt will show to whom the article was delivered and the date <br /> C delivered. Consult postmaster for fee. <br /> ij 3.Article Addressed to: 4a.Articfle Number <br /> tv <br /> 4b.Service Type m <br /> lQ 0 �,,�/ ❑ Registered 'Certified � <br /> V ' J(J?` ❑ Express Mail ❑ Insured 5 <br /> a <br /> o 5 7 '( O ❑ Retum Receipt for Merchandise ❑ COD ` <br /> a { 7.Date of Delivery <br /> cc i �• <br /> 5.Rec d By:(P,/int N ) S.Addressee's Address(Only if requested <br /> and fee is paid) <br /> 1 <br /> A- <br /> T Signat re.(A dresse or Agent) ? <br /> m <br /> X <br /> PS Form 3811, December 1994 102595-97-B-0179 Domestic eturn Receipt <br />