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. <br /> . . � <br /> . - . . <br /> . <br /> A. Signature. � ,���`' � p gent <br /> ■ Complete items 1,2,and 3.Also complete X �` � /7��(����� Addressee <br /> item 4 if Restricted Delivery is desired. _��-�. <br /> ■ Print your name and address on the reverse Printed Name) te of Delivery <br /> so that we can return the card to you. B. Received by( <br /> ■ Attach this card to the back of the mailpiece, Yes <br /> of on the front if spaCe permits. p. Is delivery address different from item 1? �No <br /> 1. Article Addressed to: If YES,enter delivery address below: <br /> �;�rd Kloc� <br /> 1 �..(�O I O�a �'i 11�N 3. Service Type <br /> ��f�1 �r ified Mail ❑ExPress Mail <br /> Registered ❑Return Receipt for Merchandise <br /> ��ho �n N �53� ❑Insured Mail ❑C.O.D. <br /> 4. Restricted Delivery?(F�ctra Fee) ❑Yes <br /> 2. ArticleNumber 7pp2 Q510 0001 6306 0889 <br /> (rransfer from servlce label) t92595-o2-M-154o; <br /> PS Form 3811,February 2004 <br /> Domestic Return Receipt <br /> � � . � . �� <br /> - . - ' ... r, .. <br /> �. • , • . . .. , <br /> o-' <br /> � <br /> � <br /> 0 <br /> � .� <br /> � Postage $ <br /> r^ A p,l.B <br /> � Gertified Fee L �� a <br /> Her�2 <br /> � Retum Receipt Fee n , Zh <br /> � (Endorsement Required) ` ��� (J� <br /> � Restricted Delivery Fee I /� <br /> � <br /> 0 (Endorsement Required) �� _ � ����uy w <br /> o �, $ SJ�q' <br /> � Total Postage&Fees _ <br /> —— <br /> � Sent To <br /> �21CktU�l K��J� - - ------------------ <br /> ------------------- - <br /> f'LI Street,Apt.No.;�`�O �� �'y��/� <br /> O or PO Box No. U �_�K�� --------------------- <br /> -- <br /> ---- <br /> - 3tv4 <br /> � Ciry,State,ZIPr � <br /> ['`- <br />