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Z 128 782 594 <br /> US Porj41.$e4W <br /> Receipt for Certified Mail <br /> No Insurance Coverage Provided. <br /> Do not use for International Mail See reverse <br /> Sent to <br /> Street&Number <br /> Post office,State,&ZIP Code <br /> Postage $ <br /> Certified Fee <br /> Special Delivery Fee <br /> Restricted Delivery Fee <br /> LO <br /> rn Return Receipt Showing to <br /> Whom&Date Delivered <br /> Q Retum Receipt 9*w4 to Whom, <br /> Q Date,&Addressee's Address <br /> TAL Postage&Fees Is <br /> r Date <br /> fS 9 <br /> SE I also wish to receive the <br /> ■Complete items 1 andio f additional following services f <br /> ■Complete items 3,4a,a g (or an <br /> ■Print your name and add as a •i return this extra fee): <br /> card to U. <br /> 8 <br /> ■Attach this form to the front ay iec ,or on thQ ck i ace does not 1.[ NeS&eQS SS <br /> � ppeermit. ` v <br /> ■Wrt a'Retum Receipt Requested'on the mailpiece below the i e r. 2.❑ Restricted Delivery <br /> ■The Return Receipt will show to whom the article was deliver a e <br /> delivered. Consult postmaster for fee. _g <br /> 3.Article Addressed to: 4a.Article Number <br /> RON VAN DE POL —-- _ ___.--- �� ✓1j>�` ��� <br /> j� <br /> VAN DE POL ENTERPRISES 4b.Service Type m <br /> P 0 BOX 1107 C3 Registered Certified <br /> ❑ Express Mail Insured <br /> STOCKTON CA 95201 ❑ Return Receipt for Merchandise ❑ COD <br /> 7. Date of Deliver _ w <br /> :2� 5.Received By:(Print Name) 8.Addressee's dress(Only if requested <br /> and fee is p d) c <br /> 6gSgn r se ItYP11,December 1994 102595-98-60229 Domestic Return Receipt <br />