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SENDER: COVPLETE THIS SECTION rOMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signatu <br /> item 4 if Restricted Delivery is desired. 0 Agent <br /> X <br /> ■ Print your name and address on the reverse 0 Addressee <br /> so that we can return the card to you. R. Received b Prinfedl+ame C. Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. �l <br /> D. Is del i ReD�1? Oyes <br /> 1. Article Addressed to: If YES, a ❑ No <br /> JACKPOT FOOD MART* NOV 1 7 2004 <br /> 14000 E HWY 88 <br /> LOCKEFORD 95237 3. S rvlce Mlb(� �......$ <br /> d Cemfie <br /> 0 Registered 0 Return Receipt for Merchandise <br /> 0 Insured Mail 0 C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) 0 yes <br /> 2. Article Number <br /> (Transfer from service label) 7n03 3110 0003 5254 318 <br /> PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 <br /> Postal <br /> pCERTIFIED MAIL. RECEIPT <br /> 0 <br /> rl (Domestic Mail Only;No Insurance Coverage Provided) <br /> M <br /> Ln F IIS <br /> N <br /> Ln Poste9a S _ <br /> 0 E3 Cori Fee <br /> 0 llr: Redept Fee POMmBrk <br /> (ErMorsemera Required) FIOfe <br /> O Reetricled Delivery Fee <br /> ri (6ufareement Required) <br /> rR <br /> frl Total Poetnae 8 Fees Q <br /> Z3 sant TO JACKPOT FOOD MART* <br /> r- -sYieer„ <br /> 14000 E HWY 88 - <br /> orPOE LOCKEFORD 95237 <br />