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COMPLETE THIS SECT <br /> ELIVERy <br /> ■ Complete items 1,2,and 3.Also complete A- Signature • ON <br /> , <br /> item 4 if Restricted Delivery is desired. <br /> ■ Print your name and address on the reverse X � <br /> so that we can return the card to you. c Agent <br /> ■ Attach this card to the back of the mailpiece, B Receiv by(Prin ed Na a Addressee <br /> or on the front if space permits. �� ) C. Date of Delivery <br /> 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes <br /> MQN E. <br /> If YES,enter delivery address below: -�No <br /> �� ��' er <br /> ,3(D� Togo <br /> 3. Service Type <br /> Orono W N �� ?`Certified Mail El Express Mail <br /> 1 V 'V ❑Registered ❑Return Receipt for Merchandise <br /> ❑Insured Mail ❑C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) <br /> 2. Article Number 11 Yes <br /> (Transfer from service label) 7002 0 510 0001 6306 1251 <br /> PS Form 3811, February 2004 <br /> Domestic Return Receipt <br /> 102595-02-M-1540 <br /> Postal Service <br /> CERTIFIED MAIL RECEIPT <br /> (Domestic Mail Only, r Insurance Coverage <br /> Ln <br /> nj <br /> M Postage $ jol <br /> M ///111 <br /> Certified Fee 2•yO OFA <br /> .-q Return Receipt Fee /t Yf <br /> E3 (EndorsementRequired) L arl <br /> er��o� <br /> CD Restricted Delivery Fee <br /> Cj (Endorsement Required) A <br /> -=1 Total Postage&Fees <br /> , 5535 <br /> $ cJ 1 S' 6 <br /> L1'7 <br /> C:) Sent To <br /> ------------- ------------------- <br /> rl! Street, - - -- -`w--------- -------------- <br /> Apt. o. <br /> t7 or PO Box��/) ----TOW <br /> /D� T <br /> City,State, P+4 - ------ ----- -------- <br /> PS Form :00 January 2001 <br />