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iii iiiiiuiniiiiii <br />999 <br />~s~~o~R.- --------- -- <br />s omp items 1 and/or 2 for additional services. <br />H • Complete items 3, and 4a & b. <br />m ~rint your name end atltlress on the reverse of this form so that we can <br />`'e rtfetli thipcard to you. <br />~ • Attach this corm to the Iront of the mailpiece, or on the back if space <br />~ does not permit. <br />~ • Write "Peturn Receipt Rapuestad" on the mailpiece below the article numbs <br />• The Peturn R¢ceipt will show to whom the article was delivered and the det <br />C deliv¢retl. <br />0 <br />1 also wish to receive the <br />following services (tor an extra <br />fee): <br />1. ^ Addressee's Address <br />2. ^ Restricted Delivery <br />insult oostmaster for tee. <br />9 3. Article Addressed ta: 4a. Article Number <br />wa6sa~ <br />a ~"'~Q~}~~t'~^ ~~ ~j~(t ~^ 46. Service Type <br />u -~ Q.S$Z ~ V'j'I' /-'_ (COL 'a7 ^ Registered ^ Insuretl <br />vi ~v ~-Certified ^ COD <br />Q O A ~ ~~C ~ 0 0~(j 7 ^ Express Mail ~ M t chat <br />~ 7. Dat F,peli e~~ /~ <br />D C/-1 (~ <br />Q <br />j 5. Signature (Addressee) 8. Addressee's Address (Only <br />r and tee is paid) <br />W <br />6. Signet IA I~ 4 <br />0 <br />~ PS vmrm 71, eeetn6er t t . u.savo.: a~eln-tee ~ R@THRE <br />;.Y....._ _... __~. .. --- - - ~ - - - -- -". <br />for <br />m <br />.~ <br />0 <br />H <br />O <br />'m <br />0 <br />L <br />.5 <br />7 <br />0 <br />O <br />T <br />C <br />w <br /> <br />