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p 419 a5l] 948 <br /> Receipt for <br /> Certified Mail <br /> M No Insurance Coverage Provided <br /> ,rtE � Do not use for International M it <br /> (See Reverse) <br /> Sent to } <br /> Street and No. <br /> P.O.,State and ZIP od W 6C—t <br /> 5-x-0, l>d <br /> Postage $ <br /> Certified Fee <br /> Special Delivery Fee <br /> Restricted Delivery Fee <br /> Return Receipt Showing <br /> to Whom&Date Delivered <br /> CD Return Receipt Showing to Whom, <br /> C Date,and Addressee's Address <br /> TOTAL Postage $ <br /> O &Fees <br /> C Postmark or Date <br /> th <br /> E <br /> 0 <br /> LL <br /> to <br /> a <br />