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v t r7y-i ✓ w b <br /> SEND I also wish to receive the <br /> •Complete items 1 and/or 2 for additional services. <br /> H ■Complete items 3,4a,and 4b. following services(for an <br /> !Print yourpame and address on the reverse of this form so that we can return this extra fee): <br /> card to you. <br /> d <br /> y ■Attach this form to the front of the mallpiece,or on the back it space does not 1. ❑ Addressee's Address <br /> m permit. d <br /> o ■Wr,re'Return Receipt Requested'on the mailpiece below the article number. Q, ❑ Restricted Delivery to <br /> Y <br /> The Return Receipt will show to whom the article was delivered and the date Q <br /> G derivered. Consult postmaster for fee. Z <br /> v 3.Article Addressed to: 4a.Article Number m <br /> ROBERT GOUNTANIS 4b.Service Type <br /> ui 1098 LOMA LINDA AVE ❑ Registered Certified o� <br /> ❑ Express Mail ❑ Insured 1 <br /> ro <br /> W MOUND MIN 55364 ❑ Return 13ac�ipt�p�tsAerghandise ❑ COD <br /> a <br /> a 7. Date,4f DoWery <br /> c <br /> 5.Received By:(Print Name) 8.Adre ,ee's Address Y if requested <br /> an fegis P00, z <br /> � .SigneV: dr a <br /> 0 <br /> 3811, Dece ber 1994 Domestic Return Receipt <br />