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COMPLETE THIs SECTION ON DELIVERY <br /> COMPLETE ' <br /> ■ Complete items 1, 2, and 3-Also complete <br /> A. Signat re ❑Age <br /> item 4 if Re*i � s }( / Add see <br /> ■ Print your nr s o t r arseso that we ItEe and B. Ike ivad lay, nt Name) C, Date of Delivery <br /> • Attach this card to the back of the mailpiece, C2l„ti, r`,? <br /> or on the front if space permits. El Yes <br /> D. Is delivery addre different from item 17 <br /> 1. Article Addressed to: If YES,enter de very address blow: <br /> ❑ No <br /> ( AP0 ��J1°l LCL <br /> e-iIQ qv r` <br /> fl 7 <br /> Q j] 3. �Sgen+ice Type <br /> Ma�fe� t C '1 � V�W�lified Mail:N0�EAiAlail <br /> ❑ '!J:')E EM,Receipt for Merchandise <br /> ❑ Insured Mail °C'.D.D. <br /> 4. Restricted Delivery?(Extra Fee) Q Yes <br /> 2. Articie Number 7002 2030 0001 7624 8840 <br /> (Transfer from service fade!) <br /> 102595.01-M-2509 <br /> PS Form 3811,August 2001 Domestic Return Receipt <br /> Postal <br /> CERTIFIED <br /> MAILT. RECEIPT <br /> co (17omestic Mail only;No Insurance Coverage Provided) <br /> ro 21 <br /> rf a <br /> p` Postage $ <br /> r� CertlFled Fee <br /> E:3 Postmark <br /> Return Reciept Fee Here <br /> d (Endorsement Required) <br /> L7 Restricted Delivery Fee <br /> M (Endorsement Requued) <br /> p <br /> ru Total Postage&Fees <br /> !ij <br /> ' U� <br /> Sent To �n <br /> b -------- 01 ---fid---- --------------------- <br /> z <br /> f` Sfroei,Apt. <br /> or PD box No. . -------- ------- ---------------- <br /> y <br /> City,State,Z1Pr4 3 S/�cr, <br /> :11 'r 1.li v <br />