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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 />�2/ - %;�t <br />/ <br />Agent <br />Addressee <br />(Printed Narpey C -4)ate of Delivery <br />D. Is Idlivery address different from item 1? ❑ Yda <br />If YES, enter delivery address below: ❑ No <br />3. Service 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 <br />(Transfer from service lab, 7012 3460 0000 0626 2252 <br />PS Form 3811, February 2004 Domestic Return Receipt 102595.02 -M -1540 <br />UNITED STATES POSTAL SERVICE <br />First -Class Mail <br />Postage & Fees Paid <br />USPS <br />Permit No. G -10 <br />• Sender: Please print your name, address, and ZIP +4 in this box • <br />�c 73 <br />ri; iirrrl► rl' riiirl�il i' rrnliririlil ►lillrrl'tlilrriirliliir'lll <br />