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1� . <br /> ; - S ' <br /> ; <br /> , . . . <br /> , , . <br /> ■ �omplete items 1,2,and 3.Also complete A. Signatur/ ` / <br /> ❑Agent <br /> item 4 if Restricted Delivery is desired. X (� � ����� ❑Addressee <br /> ■ Print your name and address on the reverse <br /> so that we can return the card to you. B. Receiv 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? �Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑ No <br /> M���-�������-- <br /> ���� M���� � <br /> -� m/ �` 3. Service Type <br /> �� �y�y ���(� �Certified Mail ❑Express Mail <br /> `»../., � <br /> 7��—��� ❑Registered ❑Return Receipt for Merchandise <br /> ��i n^ ��( ❑Insured Mail ❑C.O.D. <br /> u?� /` <br /> 4. Restrict e d De live ry?(E x t r a Fee) ❑Yes <br /> 2. ArticleNumber 70p2 051� 00�1 63�6 1015 <br /> (Transfer from servlce labeq <br /> PS Form 3811,February 2004 Domestic Return Receipt <br /> 102595-02-M-1540 <br /> . � _ - <br /> - � � ' . <br /> .. - . _ _ - <br /> � <br /> a <br /> o Ay I <br /> "'� Postage $ � � �P s - <br /> o /� � c3+ <br /> ,� Certified Fee L��O i U �71��� ZQQB N <br /> W <br /> � �9eturn Receipt Fee �,�(�i Here <br /> � (Endorsement Required) 11 <br /> � Restricted Delivery Fee VSP? <br /> � (Endorsement Required) , <br /> o $ S,�Z <br /> � Total Postage ffi Fees <br /> p Sent To����q ��/ <br /> v ' ��----------------------------------- <br /> - -- ---- <br /> - - r�(� � <br /> fL Street,Apt.No.; <br /> O orPOBoxNo. _____.-_.__ <br /> O - r,� <br /> ---� -�--------"'--"-��---------------- <br /> r, Ciry.State.--1P;4 � � —y ��f(/1(� �.,�n j•�X <br /> I �.ui�: �l k���� <br />