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3NI1 0311001V 010J'SS31d0OV Ndn132i 3Hl AO <br /> 140I1:1 3H1013dO13AN3 JO dO11V U3)IOI1S 33Vld <br /> • <br /> • <br /> SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> • Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. X 0 Agent <br /> • Print your name and address on the reverse ❑Addressee <br /> so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery <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? 0 Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: 0 No <br /> ,3rian 4- moll I u+Kiew►cz, <br /> 214E1 iCelly AVe-- <br /> [��( C /f (�(�� ��j?�]� 3. Service Type <br /> V et S( O 1`��• �`�-�53 1 y°( ertifie Mail 0 Express Mail <br /> ❑Registered ❑ Return Receipt for Merchandise <br /> 0 Insured Mail ❑C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) 0 Yes <br /> 2. Article Number 7002 0510 0001 6306 0261 <br /> (Transfer from service label) <br /> PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 <br />