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III IIIIIIIIIIIIIIII~ <br />999 <br />" SENDER: <br />o .Compete items 1 and/or 2 for additiorW services. I a150 wish t0 reCelVe the <br />a .Complete items 3, 4a, and ab. }ollowing SBfViCOS (fof an <br /> • Print your name end address on the reverse of This loan so that we can return this extra fee <br />~ <br /> <br /> <br />r card to you. <br />.Mach this form to the hoot or Ina mailpiece, or on the back it epao• does opt <br />}, ^ AddreSSOe'S Address d <br />u <br />` <br />y pannit. <br />•Wnle'Relum Receipt Fequesred'on lne mailpieoe below the adicle number. <br />2. ^ Restdcted Delivery <br />y <br />v .The Return Receipt rill Show to whom the anitle was delivered end the tlala <br />` a <br />~ delivered. .OfISUIf pOetmaetef }Or }ee. <br />f <br />N <br />O <br />~0 3. Article <br />Addressed to: 4a. <br />rticle Number v <br />a nn <br />(aJL ~Qp.U.Q.t ~ <br />5 ~ 80 <br />E <br />, "'"^' 4b. Service Type <br />v w-~ <br />~ <br />_ _ I ^ Registered 9~Certified <br />°' <br />n ' <br /> <br />D Bo,~ yy 9 ^ Express Mail ^ Insured <br />1226. <br />~ <br /> ^ Return Rece or ise COD <br />a ~i1 n ~ ~~o~ (p 7. Date of D ~ <br />o <br />= ~~y,rl,V W m~O C~»IU.r i. <br />~ 5. Received ey: (Print Name) 6. Addresse ' dress (OMq i ~quesfed ~ <br />y end lee is i <br /> 6 ~ <br /> 6 <br />Si <br />Add <br />A <br />f 0 <br />2 . <br />gn~re: ( <br />res~e or <br />ge~ <br />) ~ <br />a ~ j <br />' ece~ber t9sA' rp,~esticl Rety urn Receipt ~~ <br />_. - - _ _ I <br />P 526 418 B04 <br />