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' 1j �>�Il <br /> � � � <br /> � • • � <br /> ■ Complete items 1,2,and 3.Also complete �. Siynature, <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 retum the card to you. g. Recei by(P' ed Name� C. Dat�ff�elivery <br /> ■ Attach this card to the back of the mailpiece, , K �/L(�r � , � <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 /> �:��e. T-�m��� Um�� <br /> ��r�� <br /> ``�Q ���/ry,a'�- 1"'" 3• Sgrvice Type <br /> t--�W <br /> ��ertified Mail ❑Express Mail <br /> � � ��` , �j n ❑Registered ❑Return Receipt for Merchandise <br /> � N 7� ❑Insured Mail 0 C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. ArticleNumber 7002 0510 ���1 63�6 0407 <br /> (Tiansfer from service label) <br /> PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 <br /> • � - <br /> . � ■ <br /> . � _ � �-• <br /> I• ' <br /> �" <br /> � I <br /> � I . <br /> � <br /> '� Postage $ � • <br /> 0 <br /> c ,�STAL <br /> � Certified Fee ���� � Pos� � <br /> L �� �/G� Here � <br /> � Return Receipt Fee <br /> p I,Endorsement Required) �� Z <br /> � Restricted Delivery Fee <br /> � (Endorsement Required) ���8 �y <br /> � $ �,�L�— ls �,Vti�J <br /> � Total Postage 8 Fees <br /> tIl 'y�� �/{ ,/ �p�`''� <br /> p SentTo j%�\// 1` �1' i11V�_�I--w1J'� <br /> 1- l9- FP.tm---- ----- -- -- <br /> fL Street,Apt.No.; �j� ��� <br /> O or PO Box No. `---------------��� �----------- <br /> — — <br /> � City,State.ZIP+4 �,i '(� <br /> IV v� <br /> • <br />