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ak <br /> ON DELIVERY <br /> COMPLETE THIS SECTION <br /> SENDER: COMPLETE THIS SECTION <br /> gnature 0 Agent <br /> I <br /> ■ Complete items 1,2,and 3.Also complete X q;, �� <br /> item 4 if Restricted Delivery is desired. 0 Addressee <br /> IN Print your name and address on the reverse Received by(Prin d Name C. Date of Delivery <br /> so that we can return the card to you. B <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. D. Is delivery address different from item 1? 0 Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: 0 No <br /> Khris . <br /> Q �U, 3. Service Type <br /> 1177 ❑Certified Mail 0 Express Mail <br /> ❑Registered ❑Return Receipt <br /> O 444!2for Merchandise <br /> [� -5 ❑Insured Mail 0 C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7007 0220 0000 1989 7831 <br /> (Transfer from service label) Domestic Return Receipt 102595-02-M-1540 <br /> PS Form 3811,February 2004 <br /> rn <br /> ro <br /> � . <br /> `o Postage $ ��STA <br /> Er <br /> Certified Fee • L-$�. <br /> 2 5 �- <br /> -�postma <br /> O w �Q Here <br /> O Return Receipt Fee !f//• ��� <br /> O (Endorsement Required) 0 2011 <br /> C3 Restricted Delivery Fee <br /> M (Endorsement Required) <br /> ru Total Postage&Fees <br /> O <br /> Sent To� <br /> Itir ---------------------------- <br /> -7- <br /> C--3 ....... <br /> --------------------------- <br /> C--3 -- <br /> Street, ------------------------ <br /> 17- or PO B0 - ✓-!- - u <br /> ---------------- <br /> city,Sta P <br /> .10 ��. <br />