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z 1'28` 782 704- <br /> US <br /> 04-US Postal Service <br /> 'receipt for Certified M47,41 <br /> -No Insurance Coverage Provided. <br /> + t Do not_use_ for Intemational Mail LSee reverse) <br /> UNION ICE ETD � �;: � .' •t <br /> . " 6100 SHEILA ST <br /> LOS ANGELES CA 90040 <br /> s Mehl uettvery ree <br /> i Restricted Delivery Fee , <br /> CD <br /> cr) Return Receipt Showing to <br /> Whom&Date Delivered 1 <br /> a Relum Receipt%Wong to Whom, f <br /> Q Date,&Addressee's Address <br /> ACO <br /> 0 TOTAL.Postage'&Fees Is <br /> Postmark or Date :. <br /> Z` <br /> c" SENDER: I also wish to receive the <br /> ■Complete items 1 and/or 2 for additional services. �e following services(for an �. <br /> m ■Complete hems 3,4a,and 4b. <br /> rm sot n re1turn this extra fee): x <br /> ■Print your name and address on the reverse of this to <br /> { card to you. v " <br /> f ■Attach this form to the front of the maitpiece,or on the back if space does not 1.❑ Addressee's Address <br /> ` permit-'J <br /> 2.❑ Restricted Delivery <br /> ■Write'Return Receipt Requested"on the mailpiece below the article number. <br /> y ■The Return Receipt will show to whom the article was delivered and the date Consult postmaster for fee. <br /> = 4a.Article NumberEt <br /> , <br /> i 4b.Service Type <br /> a urrlara ICE ETD m � i <br /> 61.00 SHEILA ST ElRegistered ®,Certified <br /> ❑ Express Mail ❑ Insured 4 <br /> LOS ANGELES CA 90040 <br /> ❑ Retum Receipt for Merchandise ❑ Col <br /> 7.D 67ary o I <br /> 1 5.Received By: (Print Name) 8.Addressee's Addr Qnly if r sted Y <br /> and fee is paid) ?; <br /> x 6.Si gnat ' <br /> 9 r s ent <br /> A 1 , <br /> o X ;II I <br /> Ps Form 3811, Decembe 994 102595-9e-80229 Domestic Return Receipt <br />