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� . . . . <br /> � r <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. X ❑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 Kem 1? �YeS <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑No <br /> C�r o �• ��'�" <br /> � � <br /> �lo Cn��n �m�" u- <br /> w , 3. Se ice Type <br /> �`� �{�, � r�-5 �� �ifled Mail ❑Express Mail <br /> ❑Registered ❑aetum Receipt for Merchandise <br /> �� •��� �� `C�I ❑Insured Mail ❑C.O.D. <br /> Y 4. Restricted Deliver)/1(Extra Fee) ❑Yes <br /> 2. ArticleNumber 7pp7 2680 ��02 3457 2�1� <br /> (fransfer from service laben <br /> PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 <br /> � • C��r33�5 ��� <br /> ' ' C� <br /> o �� � y �:.z.. <br /> a <br /> o _ <br /> r1.i <br /> rti <br /> � <br /> � Postage $ , �� �gPY M�, <br /> m Certified Fee � �P S��y • <br /> flJ � � � Postmark <br /> O Retum Receipt Fee <br /> � �' �$7�2�1� � <br /> O (Endorsement Reqwred) �� J ae �UN <br /> O <br /> Restricted Delivery Fee > <br /> ��'�Endorsement Reqwred) � <br /> � �^�r G . <br /> `p Totat Postage&Fees � 5 1,!�. _� U�p.� <br /> f1J <br /> —�, <br /> o ��Sent _—____-__� � <br /> r.-- Qr_. e._ • � r-- -- - ------------------- <br /> r- i �'�►�����-------- - - <br /> Street t <br /> � �nrPO i <br /> �_-_�--------'-----'---' <br /> . .. - '-------� <br /> �y�� �_ <br />