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iii iiiiiiiiuiii iii <br /> <br />o SENDER: <br />v •COmDleta items 1 and/or 21or atldiaorull services. <br />a •Cpnplete items 3, 9a, and Ib. <br />~ • Pnnl your name and address on Iha reveres pf this form so Net we can return this <br />d wrtl to you. <br />~ •Atlazh This form to the horn of the mailpiece. or on the back it space does not <br />permit. <br />• Wdta'flelum fleceip( flequesred' on the meilpiece below Ne amide number. <br />•TTB Relum Receipt will show to wham Iha snide was tlalivered end the tlata <br />~ tleliveretl. <br />O <br />~ 3. Article es d't_o;`_ .,, ,~ I ~I , <br />n C j .. <br />U <br />r t ~1~~c~d ~ _ <br />~~O~Z <br />~ 5. Received By: (Print Name) <br />f <br />w <br />6. S~,atur~e: (Addressee or Agent) <br />a n~ <br />I also wish to receive the <br />following services (for an <br />extra fee): ai <br />1. ^ Addressee's Address <br />2. ^ Restricted Delivery y <br />Consult postmaster for tee. <br /> <br /> <br />_ <br />~4b. Service Type <br />d <br />^ Registered ^ Certified m <br />^ Express Mail ^ Insured ~ <br />^ Return Receipt for Merchandise ^ COD <br />7. Date of Delivery <br />/Q ~~ <br />T <br />~ <br /> <br />8. Ad ressee's Address (On y i/requested ~ <br />and /ee is paid) i <br /> izr lz~ a~(~ <br />f- <br />Ps Form 3811, December tssa uomeses rteturn fiecelpt <br />