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iii iiiiiiiiiiiuiii <br />999 <br />• Complete items 1 end/or 2 for additional services. <br />• Complete items 3, and 4e 6 b. <br />• Print your name entl adtlress on the ravar•e of this form sa that we can <br />return this card to you. <br />• Attach [his form tc [ha front of the mailpiece, or on the beck if apace <br />tloea not permit. <br />• Write"fleturn Receipt Reeueated"on the mailpiece below the article numbs <br />• The Return Receipt Fea will provide you the signature of the paracn deliver <br />to end the data of delivery. <br />title Addressed to: n~7 <br />1 iy, ct.l.dlA..i.77 ~ 5~-t.tt,l6c~ <br />~ ~.~p-~„-~, c~ 3c~c~ z J <br />November <br />I also wish to receive the <br />following services (for an extra <br />}BB): <br />1. ^ Addressee's Address <br />2. ^ Restricted Delivery <br />4a. Article Number <br />P Qinn ~7 <br />^ Registered ^ Insured <br />.Certified ^ COD <br />^ Express Mail ^ Return Receipt for <br />7. Date Of Delit <br />Addressee's Address (Only if requested <br />and fee is paid) <br />Spec, cm <br />t=ile# ~ 170 694 <br />. e f fed Mail Receipt", <br />No Insurance Coverage Provided a <br />~ Do not use for International Mail ~ <br />~^tt^;~ (See Reverse) <br />m <br />c <br />O <br />0 <br />IL <br />(n <br />a <br />Senl m d <br /> <br />alrtet 6 No. <br />55 M . t) <br />P.O.,SWa 621PCOda <br />n, <br />1.11 <br />~(~ <br />Poslege <br /> 3 <br />CeNhed Fee T <br />special Dalisery Fee - <br />--~ N <br />Reshicled D¢Ine Fee i <br />~\ ~ ^ ~ <br />Retum Receipl Showing ! ~ ~ 0 <br />m Wnom 8 OsQ pelivBiM , , , % (p <br />Retum Recelpl~S mg m~'llo~ <br />' h <br />('1 ~ <br />Date, d btlresa d liver~j `• ~ ly ~ <br />TOTAL Postage ~. <br />(` <br />H <br />'~ ~ ? <br />6 Fees ~ <br />~, . <br />Postmark or Date 0 <br /> <br />