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d SENDER: <br /> ■Complete items 1 andlor 2 for additional services. I also wish to receive the <br /> rn ■Complete items 3,4a,and 4b. following services(for an <br /> � ■Print your name and address on the reverse of this form so that we can return this extra fee <br /> card to you. 4; <br /> ■Atttach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address Z <br /> y ■Write'Retum Rece�gt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery <br /> L„ ■The Return Receipt will show to whom the article was delivered and the date <br /> delivered. Consult postmaster for fee. a <br /> o ?; <br /> 3.Article Addressed to: <br /> 4) 7001 2510 0005 9632 0845 <br /> CL <br /> E 4b.Service Type <br /> 0 MR COLDANI ❑ RegisteredX Certified E <br /> Cn <br /> Cn <br /> W 1319 9 N RAY RD ❑ Express Mail ❑ Insured .is <br /> cc LOD I CA 95242 ❑ Return Receipt for Merchandise ❑ COD <br /> 0 7. Date of Delivery <br /> cc <br /> 5. Recei�ad By: (print Name) 8.Addressee's Address(Only if requested <br /> and fee is paid) <br /> 6.Signature:(Addressee or Agent) <br /> oX , <br /> 4 L <br /> PS Form 3811, December 1994 102595-97-B-0179 Domestic Return Receipt <br />