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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br />■ Complete items 1, 2, and 3. Also complete A. Signature <br />item 4 if Restricted Delivery is desired. ElAgent <br />X <br />■ Print your name and address on the reverse ❑ Addressee n w 1 <br />so that we can return the card to you. B. Received by ( Printed Name) C. Date of Delivery lJ <br />■ Attach this card to the back of the mailpiece, <br />or on the front if space permits. , <br />1. Article Addressed to: <br />D. Is delivery address different from item 17 1:1Yes <br />If YES, enter delivery address below: ❑ No J <br />Sqr\ Ja�c�w`n Goun� <br />��RgrncK sem ce s <br />9, <br />00,, G1 0 3. Service Type <br />t~M 129 Certified Mail O Express Mail <br />222 EA6�- ❑ Registered IQ Return Receipt for Merchandise ,.j. <br />'15 ❑ Insured Mail ❑ C.O.D. di <br />Coax LVA 16f <br />4. Restricted Delivery! (Extra Fee) ❑ Yes <br />2. Article Number V r <br />ahvisfier from service Label) 91 7108 2133 3930 9537 6696 <br />\_ <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 <br />�+ (� -.j ter. <br />1' 0 <br />0 <br />L - <br />w <br />w <br />LU <br />Lu <br />G <br />Cr <br />0 <br />�o <br />--Jr- vj G V-1 <br />