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• Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery Is desired. <br />• Print your name and address on the reverse <br />so that we can return the card to you. <br />• Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />A. Signature <br />❑ Agent <br />X ��� �v - ' �— ❑ Addressee <br />B. Received by ( Printed Name) C. Date of Deliv <br />,i <br />D. Is delivery address different from item 1? 11 Yes <br />If YES, enter delivery address below: ❑ No <br />3. SSer4ce Type <br />WCertified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Maii ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number <br />(Transfer from service label) 7009 2 8 2 0 0003 5 7 0 0 8070 <br />PS Form 3811, February 2004 Domestic Return Receipt <br />102595 -02 -M -1540; <br />om— 2000— 0�50 <br />I _2--o_,z <br />- <br />�� <br />,,� : D,2 ✓y1s <br />fn H 0- <br />