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j <br /> t <br /> 'NDER: i <br /> _aO-"'"Complete items 1 and/or 2 for additional services. I also wish to receive the <br /> 'Z *Complete items 3,4a,and 4b. following services for an j <br /> at ■Print yo8r name and address on the reverse of this form so that we can return this extra fee): <br /> card to you. d <br /> j ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 2 j <br /> a) permit. <br /> a, ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery U) <br /> ■The Return Receipt will show to whom the article was delivered and the date <br /> c delivered. Consult postmaster for fee. a <br /> o 0 <br /> 3.Article Addressed to: 4a.Article Number (D <br /> mT /� <br /> E �Iv tQt"e N SMS d Pf 4b.Service Type <br /> C ( Sd Registered Certified Q <br /> ¢ S ` c r _t u' ^ ❑ Express Mail KT �❑`Insured y <br /> �-p K TY� ( moi q 5-99)-�-, ❑ Retum Receipt(orftercFa—hdise ❑ COD ' <br /> a1 7.Date of Delive. <br /> 4, y,c/y-� L. I �� <br /> `, o :. <br /> Z5. cEived By: (P ame) e.Addressee's-Address(Only Yrequested ' <br /> LU and fee is paidj���;' _ <br /> 6. ignature: (Addressee or Ag \%�J ~ <br /> o X <br /> m <br /> PS For,3811, December 1994 Domestic Return Receipt <br /> P 291 488 875 <br /> US Postai Service <br /> Receipt for Certified Mail <br /> No Insurance Coverage Provided. <br /> Do not use for 1International Mail See reverse) <br /> 111 <br /> -1 oo�t P t tc-af'r <br /> Street&Number <br /> I S I 6-C.f4 �a <br /> Post ice,State &ZIP Code <br /> SToc.k RS�o <br /> Postage <br /> Certified Fee / <br /> Special Delivery Fee <br /> Restricted DO, <br /> f��1q <br /> rn Return Vc owi 9 d <br /> Whom jk Da Deli cfl r <br /> a Returneip Slowing t <br /> Q Date,& dr ee's Addss <br /> OTOTAL s e� ees <br /> Go $v civ <br /> C') Postmark o $ <br /> E <br /> 0 <br /> U- <br /> co <br /> fL <br />