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Postal <br /> aCERTIFIEDRECEIPT <br /> T. <br /> (Domestic Mail Only;No Insurance Coverage Provided) <br /> For delivery Information visit our website at www.usps.corri <br /> ru <br /> Postage $ <br /> O <br /> Certified Fee <br /> 0 Return Reciept Fee Postmark <br /> (Endorsement Required) Here <br /> C3 Restricted Delivery Fee <br /> M (Endorsement Required) <br /> O <br /> rl_I Total Postage&Fees <br /> ru <br /> c3 Sent To <br /> ID <br /> --------- <br /> ------------------------------ <br /> r` Streei,Apt.No.; :�" <br /> l <br /> or PO Box N-- aJ/�� I r ty` 1 Il <br /> City,State.ZIP+4 <br /> 6 k--fi PS Form 3800,June 2002 See Reverse I <br /> COMPLETE THIS <br /> SECTION . <br /> SENDER: cOMPLETE THIS,,SEPTIOU <br /> ■,Comple` items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. t of D,liv ry <br /> item 4 if Restricted Delivery is desired. ✓ <br /> ■ Print your name and address on the reverse Si natur <br /> so that we can return the card to you. t <br /> ■ Attach this card to the back of the mailpiece, X ❑Addressee <br /> or on the front if space permits. D. Is delivery address differen t from item 1? ❑Yes <br /> 1. Article Addressed to: If YES,e"tMn. <br /> L_/ No <br /> 'JUL 2 7 2004 <br /> 3. Service rpt HEALTH <br /> ❑Certified PERf1RVICiZS <br /> l/ ❑ Registered El Return Receipt for Merchandise <br /> ❑ Insured Mail ❑ C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number(Copy from service label) ?002 2030 0001 7624 ?461 <br /> PS Form 3811,July 1999 <br /> Domestic Return Receipt 102595-00-M-0952 <br />