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k � <br /> C1. SENDER. <br /> I ■Complete items 1 and/or 2 for additional services. <br /> M ■Complete items 3,4a,and 4b. I also Wish to receive the _ <br /> ■Print your name and address on the reverse of this form so that we can return this <br /> following services(for an <br /> card to you. extra fee): <br /> permit.this form to the front of the mailpiece,or on the back if space does not d <br /> e 1. ❑ Addressee's Address <br /> 0Write'Return Receipt Requested'on the mailpiece below the article number. <br /> The Return Receipt will show to whom the article was delivered and the date 2. 1:1 Restricted Delivery to <br /> c delivered. <br /> ° Consult postmaster for fa <br /> d 3.Article Addressed to: fee. <br /> I <br /> 4a.Article Number U_d _ d <br /> CL &2 i Co&7 ir <br /> 0 4b.Service Type. 5 <br /> CI x-71 1 ❑ RegisteredAR Certified cc <br /> ❑ Express Mail-, �`" El Insured <br /> El Return Re4eipl er COD <br /> a 7.Date of Delivery o` <br /> z _ .0 o <br /> cr Op_jeqested 5.Received By:(Print Name) 8.Addressee s Address Ow (and fee ispatd) r <br /> c6.Signature:(A r see>orAgent) �c�sJ I <br /> .PS 1= 11,Decemb rasa Domestic Return Receipt <br /> i <br /> i <br />�I <br /> II ' <br /> I <br />