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� , . . . . <br /> ■ Complete items 1,2,and 3.Also complete Signature , <br /> item 4 if Restricted Delivery is desired. ; �r,.. �,I'/� '' Agent <br /> ■ Print your name and address on the reverse Y �t., , f��.b'� Addressee <br /> so that we can return the card to you. , ec ived Pri d m � C D i ry <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. <br /> D. Is delivery address different from item 1? Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: <br /> I�o�dd� �'Q �QX �°I�, <br /> ��� � <br /> ��-�o � �- t� <br /> � �� 3. Se i YPQ <br /> `'C�I ,V/ �Certified Mail 0 Express Mail <br /> yt.� f egistered ❑Retum Receipt for Merchandise <br /> � i ❑ Insured Mail ❑C.O.D. <br /> � 4. Restricted Deliveryl(Extra Fee) ❑Yes <br /> 2. Artic�eNumber 70�2 0510 00�1 6306 0575 <br /> (Tiansfer from service labe� <br /> PS Form 3811,February 2004 Domestic Retum Receipt iozsa�o2-►u�-�sao <br /> . � <br /> � � . <br /> ., + <br /> � <br /> r� <br /> � <br /> 0 <br /> � Postage $ �� • <br /> � /� �y. gSAL eq <br /> � Certified Fee L�X Q• y <br /> y Pos <br /> ,� Return Receipt Fee i/U� He <br /> p (Endorsement Reqwred) _ � �� � <br /> � Restricted Delivery Fee � 1OJ0 �w <br /> � (Endorsement Required) <br /> � Total Postage&Fees � 5•{�_ ps w • <br /> --. <br /> � --��----------- ��— . <br /> p Sent � ' <br /> - --�"1lC.l'1Ue�---ltila�.d�� ------------------- _ � <br /> � S[reet, j�� ��� <br /> O orPOf���F`�_.._�!-�– .. ... _.__ ��� <br /> � - --�-----------�--� --------- ' <br /> � City,S ZIP 4 � y�w � � '� <br /> J r► <br /> . :�� �� - <br />