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SENDER <br /> 1COMPLETE <br /> Complete items 1,2,and 3.Also complete A. Received by{Please Print Clearly) B. Date of Delivery <br /> item 4 if Restricted Delivery is desired. <br /> a Print your name and address on the reverse <br /> so that we an ret n e car to you. C. Signat <br /> M <br /> ■ Attach this ill Qb the mailpiece, X r-7) ❑Addres <br /> rtU or on the front if space permits. El Addressee <br /> tv D. Is delivery address diffWWt from item 1? ❑ Yes <br /> 1. Article Addressed to <br /> m If YES,enter delivery address below: ❑ No <br /> M r.: <br /> jl <br /> C3 KAREN PETRYNA <br /> n <br /> EQUIVA SERVICES LLC 3>s<e ',.rtified <br /> ce Typev P 0 BOX 7869 Mail C3Expl�9s Maio <br /> ❑ egistered ❑ RetW Receipt for Merchandise <br /> "11 BURBANK CA 91510-7869 <br /> [3 insured Mail ❑C.O.D. <br /> Ln <br /> FU 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> a <br /> p2. Article Number(Copy from service label) <br /> C3 C7-00 1a/ <br /> C+- <br /> PS For 38 1,Jul X99 Do stic Retu Receipt 102595-00 <br /> /W �04 <br />