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Z 128 782 698 — <br /> US Postal Service <br /> Receipt for Certified Mail <br /> No I surancevoneg'Provided..*Mse for international Ms#- 6aerse <br /> no� IYit+ <br /> SentlCo`R-hn�Q� 00>% <br /> StreetpOmA., ,,4l` <br /> Past A-L ZIPG L- d. rJ 573^f <br /> postage $ <br /> Certified Fee <br /> Special Delivery Fee <br /> Restricted Delivery Fee <br /> mReturn Receipt Showing to <br /> Whom&Oale Delivered <br /> rn RewIn RecsiNSnst'"gmWfiOm• <br /> Date,&Addressees Address <br /> O TOTAL Postage&Fees $ <br /> ccq postmark or Data <br /> 0 <br /> LL -- <br /> ------------- <br /> N <br /> J° 0- <br /> I also wish to receive the <br /> $ SENDER: W N following services(for an <br /> .Complete Items 1 and/or 2 for additional services. extra fee): <br /> and 4b. that we can return this Z <br /> Complete nems a,aa, 1.0 Addressee's Address <br /> .pant your name and address on the reverse Orton he ack if space does not 2 0 Restricted Delivery <br /> Icard to yYou. <br /> > .Attach IhIs form to the front of me mallpleCe, <br /> ppee��t' t Re uested'on the mail lace below the article number. Consult postmaster for fee. <br /> •Wdte'Retum Receipt 4 <br /> •The Pat,Receipt will show to whom the article was delivered and t4a date <br /> Number 2 <br /> deiivered. ga G 9fr <br /> 3.Article Addressed ' <br /> 3 <br /> $� �L�� �p� 4b.Service Type Certified ¢ <br /> n � O OX ' , I ❑ Registered <br /> Y [3 Insured c <br /> ❑ Exp ress all w <br /> ❑ Ret urn Re {Ae alai 11 COD IS <br /> o <br /> ti7.Data of. c <br /> 67 T <br /> Addre ee Ac <br /> ,fOnl .it'requested <br /> y a <br /> 5.Received By:(Print Name) and tee's id) <br /> 6.Sign ddressee or A ent) - Spy 95�� <br /> p 1025959eE-0229 Domestic Return Receipt <br /> T <br /> 9 PS Form 3811 ecember 19 4 <br />