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. . . . . . . <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 item 1? ❑Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑No <br /> Ci�� � �I(�Ck�Sbn <br /> �/ '� I ��] � ��1'/1 3. ServiceTYpe <br /> V W�`� ��� (�L'�rtified Mail ❑F�cpress Mail <br /> J ❑ Registered ❑Return Receipt for Merchandise <br /> ' � V■ �� `��� ❑ Insured Mail ❑C.O.D. <br /> �jl� 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. ArticleNumber 7p02 051� 0001 6306 0827 <br /> (Transfer from service labe� <br /> PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 <br /> • , p "1'' <br /> Ivn�\ <br /> .. . <br /> ,t -._.._--- <br /> � <br /> � . <br /> 0 <br /> � Postage � ,� � <br /> O <br /> --_ _ _ .{ <br /> � Certified Fee C�, p`���q . <br /> . �v __ 'Q,�l P�stT �i <br /> ,� Retum Receipt Fee n � 9�C ��"' 2 <br /> � (Endorsement Required) '`,� <br /> � Restricted Delivery Fee ,J�j f� <br /> 0 (Endorsement Required) �Og �W <br /> O � <br /> � Total Postage&Fees � _�_ _, �S1A <br /> u7 ------ <br /> 0 Sent To T {�"'�.�1 �i�/r� <br /> ----- --- --- <br /> V Iri VJ V --- ---------------- <br /> fl.l Street . � n� � ��� <br /> O or PO:�''�� <br /> -----------' <br /> � City. ,. " � <br /> — Y/ <br /> :11 �� <br />