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Z OL6 974 017 <br /> Receipt for <br /> Certified Mail <br /> No Insurance Coverage Provided <br /> Do not use for InteM a Tonal Mail <br /> (See Reverse) 117 G <br /> Seq�o <br /> Street pno <br /> P.O.,State and ZIP'Code <br /> Postage <br /> Certified Fee V <br /> Special Delivery Fee <br /> Restricted Delivery Fee <br /> Return Receipt Showing <br /> t to Whom&Date Delivered <br /> r <br /> t Return Receipt Showing to Whom, 5� <br /> WDate,and Addressee's Address p <br /> TOTAL Postage ` <br /> O &Fees <br /> QPostmark or Date <br /> M <br /> E <br /> 0 <br /> LL <br /> CO <br /> a <br /> SENDER: <br /> y nplete items 1 and/or 2 for additional services. <br /> I also w .,;ve the <br /> N iplete items 3,and 4a&b. Ices (for an extra d <br /> rrmt your name and address on tee): j <br /> > return this card to you. <br /> • Attach this form to the front of the mailpiece,or on the back if space 1. EJ Addressee's Address <br /> does not permit. N <br /> L • Write"Return Receipt Requested"on the mailpiece below the article number. d <br /> • The Return Receipt will show to whom the article was delivered and the date 2. El Restricted Delivery Z <br /> c delivered. Consult postmaster for fee. Q <br /> 3. Article Addressed to: 4a. Article Number <br /> U ` <br /> C / fG L(I� /�/ 4b. Service Type <br /> v e��� C.�T.�4 El Registered ❑ Insured <br /> , ,- tM <br /> tAI / 10'Certified ❑ COD c <br /> d�-rR r� yZ ❑ Express Mail [:] Return Receipt for 03 <br /> C g <br /> p Merchandise <br /> 7. Date of Deliver r- <br /> in <br /> 5. Si a ure (Addressee) 8. Addressee's Address (Only if requested - <br /> and fee is paid) <br /> w= 6. Signature (Agent) <br /> 0 - <br /> HPS form 3811 December 1991 *U.S.GPO:1993-352-714 DOMESTIC RETURN RECEIPT <br /> 6 Ya l Lir ,( a-,,. - <br />