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N <br /> Z 128 782 692 <br /> US Postal Service <br /> Receirt for Certified Mai! <br /> No Insurance Coverage Provided. _ <br /> Do not use for International Mail See reverse <br /> Sent (¢ <br /> Street & Number <br /> � 7 S '-( F c' c) x'"ni Vlflle <br /> Post Office State & ZIP Cede <br /> Postage $ <br /> Certified Fee <br /> - <br /> Spa <br /> dal Delivery Fee <br /> Restricted Delivery Fee <br /> N <br /> m Relum Receipt Showing to _ <br /> Whom & Date Delivered <br /> Return Receipt Showing to Whom, <br /> < Dale, & Addressees Address <br /> mTOTAL Postage & Fees Is <br /> fmark or Date <br /> 9 <br /> r ACE_ <br /> TENDER: I also wish to receive the <br /> • Complete items t and/or 2 for additional services. followin services for an <br /> w Complete Items 3, 4a, and 4b. 9 <br /> r. <br /> Pont nt yod toyur name and address an the reverse of this form so that we can return this extra fee): <br /> - • ou <br /> Attach this form to the front of the mailpiece, or on the back If space does not 1 . ❑ Addressee's Address cf <br /> •Wn Write Receipt Requested" on the mailpiece below the rufficle number. 2. ❑ Restricted Delivery v <br /> ■ The Return Receipt will show to whom the article was delivered and the date Consult postmaster for fee. N <br /> delivered. P a <br /> 0 3, Article Addressed to: 4a. Article Number <br /> r aFr 7S Z 5y fs <br /> a 4b. Service Type <br /> FLO9744 FOBUNrPAIN V 11 Registered 0 Certified <br /> aLLVy ❑ Express Mail ❑ Insured <br /> STO <br /> W CKTON CA 95200 ❑ Return Recelpt for Merchandise ❑ COD <br /> 0 7. Date I Delivery o <br /> requested <br /> O <br /> 5. Received By: (Print Name) 6. Addressee's Address (Only if ted Y <br /> and fee is paid) t <br /> 6. Signa>� : ( ddresse orA <br /> A <br /> r—e PS FomV3811 , December 1994 102595-ga-B-0229 Domestic Return Receipt <br /> I <br />