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ai SENDER: I also wish to receive the <br /> _ <br /> •v ■Complete items 7 and/or 2 for additional es. <br /> ■Complete items 3,4a,and 4b. following services(for an <br /> 0 ■Print your name and address on the reverse of this form NO.return this extra fee): <br /> card to you. <br /> ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address Z <br /> permit. <br /> d ■Wnte'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N <br /> ■The Return Receipt will show to whom the article was delivered and the date a <br /> delivered. Consult postmaster for fee. <br /> 3.Article Addressed to: 4a.Article Number� <br /> L `C <br /> CIRCLE K STORES INC 4b.Service Type � <br /> PAM DUGAN LICENSE DEPT ❑ Registered �tgertifled Go <br /> P O BOX 52085 ❑ Express Mail [3Insured E <br /> ❑ Retum Receipt for Mefchandise [3 COD <br /> PHOENIX AZ 85072-20850 <br /> 7.Date of Deliypy 1 4 i gg8 'o <br /> uLli � <br /> 5.Received By:(Print Name) 8.Addressee's Address(Only If requested <br /> and fee Is paid) r <br /> I— <br /> g 6.Signature:(A drrAgent) <br /> a°. X <br /> a <br /> PS f=orm 3894,December 18%4 102595-97-B-0179 Domestic Return Receipt <br />