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' � . . <br /> . . . <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 � � ,� <br /> so that we can return the card to you. Addressee <br /> ■ Attach this card to the back of the mailpieCe, B- R eived y(Printed Name) C. Date of Detivery <br /> or on the front if space permits. � ) ` i�— _ _� <br /> 1. Artio(e Addressed to: D. Is delivery address d'rfferent from Rem 17 �Yes <br /> If YES,enter delivery address below: �o <br /> V�I� 11 idm L. S�h�;-� <br /> �`� N�,� A�'� I�Y. 3. SeNt�T�e <br /> ���y�AAA �.Certfied Mail ❑Eupres,q Mail <br /> (/�/�� ``�G7 ' /� ❑Regfstered ❑Retum Receipt for Merchandise <br /> r� � K���;�+ ❑Insured Mail ❑C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2, Article Number <br /> (Transfer from service/abelJ 7 0�7 �2 2� ���0 19 8 9 7 51,� <br /> : PS Form 3811, February 2004 Oomestic Return Recetpt <br /> 102595-02-M-1540 <br /> • � <br /> � , � _ � <br /> � ' <br /> r� �' • � _ <br /> �1 <br /> f� <br /> p� � � �� � <br /> � �e.-� M� �z ;,, <br /> � Postage $ .�' <br /> r� <br /> � Certifled Fee I�ifl �P�BAY,� <br /> � Retum Recelpt Fee O'✓ G) Post <br /> 0 {Endorsement Required) �� Here � <br /> O <br /> Festricted Del(very Fee NQ�J _ W <br /> � (Endorsement Required) 1 1010 w� <br /> fU t <br /> � Total Postage 8 Fees � � 1 ` <br /> O .� <br /> � Sent T � ~` <br /> _._.._---- <br /> � ------ ----'--��I�IM__.�.._ �'l_�i_ <br /> p Stree p No.; """ <br /> •---------------------�------ <br /> � orPO o��---^,?��'}(n !'�.,✓�n • <br /> City, e,ZIP�a �'���uj 1!1. I31�• �---� <br /> ---'------------------------ <br /> �W <br /> :�� ��. <br />