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j <br /> I SENDER: 'tet <br /> v ■Complete items 1 and/or 2 for additional services.0—D�_ 1 also wish to receive the <br /> q ■Complete items 3,4a,and 4b. following services(for an <br /> m ■Print your name and address on the reverse of this form so that we can return this extra fee): <br /> d 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 <br /> 2 permit. - <br /> m ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N . <br /> ■The Return Receipt W sthuy togh9 f tMe was delivered and the date <br /> c delivered. F'11 1C `t LUUU �irll tv Consult postmaster for fee. <br /> 3.Article Addressed to: 4a.Article Number d ` <br /> t; a 7 F c <br /> E 4b.Service Type <br /> a JIFFY LUBE/BROADWAY INC ❑ Registered Certified c <br /> 81 3990 WEST YOSEMITE ROAD ' ❑ Express Mail ❑ Insured P <br /> W LATHROP. CA 95330 <br /> rr i ❑ Return Receipt for Merchandise ❑ COD <br /> ae 7.Date-ol Date-oDelivery <br /> S <br /> S.Received By: (Print Name) 8.Addre ee's A ress(Only if requested <br /> C Q and fee is paid) c <br /> t— <br /> g 6.Sig tura:(Addressee orA ant) ' <br /> a°. X <br /> rn <br /> PS Form 3811, December 1994 102595-97-B-0179 Domestic Return Receipt r <br /> fi <br /> Z - 128 784' _330 <br /> US Postal Service : <br /> 1 <br /> 13etfor Certified Mail <br /> JIFFY LUBEBROADWAY INC )- j <br /> i. 3990 IVES- <br /> . 'YOSEMITE ROAD <br /> LATHROP CA 95330 <br /> Postage $ <br /> Certified Fee " s' <br /> Special Delivery Fee e <br /> Restricted Delivery Fee <br /> rn <br /> Return Receipt Showing to <br /> Whom&Date Delivered <br /> n Return Receipt Showing to Whom, <br /> Q. Date,&Addressee's Address <br /> QTOTAL Postage&Fees. $ _ <br /> Postmark or Date <br /> C0 u <br />