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P 581 455 X61 <br />T 'RECEIPT FOR CERTIFIED MAIL <br />NO INSURANCE COVERAGE PROVIDED <br />NOT FOR INTERNATIONAL MAIL <br />(See Reverse) / hs-' 9 <br />"a <br />a <br />0 <br />a <br />N <br />a <br />Sent to <br />Street Tnd No. 14 <br />J <br />C- <br />P O.. State d ZIP Code <br />?TiLC d <br />Postage <br />5 .75 <br />Ceditied Fee <br />4� <br />0 <br />Special Delivery Fee <br />Restricted Delivery Fee <br />Return Receipt showing <br />to whom and Date Delivered <br />- 4a <br />Return Receipt showing to whom. <br />Dale, and Address of Delivery <br />TOTAL Postage and Fees <br />S ^ DO <br />of <br />Postmark or Date <br />