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Z 016, 974 007 <br /> Receipt for <br /> Certified Mail <br /> No Insurance Coverage Provided <br /> Do not use for Inter at' nal Mail <br /> (See Raver,el / r' <br /> Sani <br /> yy � <br /> sr !Sn�bO� <br /> P.O,Sate n ZIP Code <br /> 30 0 <br /> Postage u $ <br /> 9 � <br /> Certified Fee <br /> Special Dellvery Fee <br /> fleselcted Dellvery Fee <br /> O flewm Receipt Showing ,�1 <br /> Cle to Whom&Date Delivered <br /> L Return Receipt Showing to Whom, \\ <br /> Date,and Addressee's Address <br /> m <br /> TOTAL Postage <br /> &Fees <br /> n, <br /> OGo Postmark or Date <br /> Ol <br /> O <br /> LL <br /> wislionsious <br /> !n <br /> a <br /> �. <br /> v SENDER: ' ' ' ' <br /> ME=h to receive the <br /> 'y • Complete items 1 and/r- - .,. <br /> e • Complete items 3,an( t b. followinc vices (for an extra 4 <br /> N • Print your name and so...as on the reverse of this form ao that we can fee): <br /> O return this Card to you. Y <br /> 11. • Attach this form to the front of the mailpiace,or on the back if space 1. El Addressee's Address <br /> CO) <br /> m <br /> does not permit. «� <br /> L • Write"Return Receipt Requested"on the mailpiace below the article number. <br /> « 2. El Restricted Delivery o <br /> • The Return Receipt will show to whom the article was delivered and the date o <br /> e delivered. Consult postmaster for fee. <br /> m 3. Article Addressed to: 4a. Article Number <br /> ti Z a /67Y 007 r <br /> CL 4b. Service Type <br /> S lT�-dL-c°JL ❑,—,�Registered ❑ Insured <br /> 0 1L�1a 6 b act,ertified ❑ COD .e <br /> 0 �r =Receipt for rh <br /> El Express Mail ❑ Merchandise <br /> Lu <br /> 14 9533 a 7. Date of Delivery <br /> Z 5. Signai as e) S. Addressee's Address(Only if requested Y <br /> and fee is paid) m <br /> L <br /> 6. Signature (Agent) ~ <br /> 0 <br /> > PS Form 3811, December 19�91 R�u.s.GRo:tssa—asz-]14 DOMESTIC RETURN RECEIPT <br /> = 1,5-1,6() & M�-c+-t-C+e-•— 0o+'�p ' <br />