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1 "i)1C) -0 ", <br />a,Y41 fl"ej M o-i <br />Cgfhplete items 1, 2, and 3. Also complete <br />itea4 if Restricted Delivery is desired. <br />PrW your name and address on the reverse <br />sO3} at we can return the card to you. <br />Attbh this card to the back of the mailpiece, <br />or cfR the front if space permits. <br />ArtRe Addressed to: <br />1J <br />LckvvM\p) CO 3 Io a <br />0 Agen <br />0 Addre <br />calve (Printed Name) =Date i <br />Is del' ery �s different from item 1? 0 Yes <br />If YES me ell veryfddsg below: 0 No <br />3. Se O. Type c Z <br />w <br />Ce Mail E3 va - - <br />Qj Regis 05 i�Ag{bm�Merct <br />0 Insured Mail 0 C.O.D. <br />4. Restricted Delivery? (Extra Fee) 0 Ye <br />rticle Number <br />ransfer from service label) 7012 3460 0000 6384 8260 <br />-Orm 3811, February 2004 Domestic Return Receipt <br />102595= <br />(Domestic Mail Only; NA, Arrsurarc�a 4averag <br />For delivery information vss our v'� —� <br />• • •_ <br />$2.70 <br />USpS 'ostmark <br />$6.48 Here <br />Restricted Delivery Fee <br />C3 (Endorsement Regwred) <br />..0 <br />,I Total Postage & Fees $ <br />M <br />ru 1pv'v�, Y�iu�eN�lic�o <br />r - - --- -- Lt( <br />l: Street, Apt No.;------------------ I <br />or PO Box No <br />v� <br />M1 City State, ZlP +4 0 - - -- <br />ZClv�av� CO Slob <br />