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C.. SENDER: <br /> .8 ■ <br /> Complete item: and/or 2 for additional services. I also wish to receive the <br /> ■Complete item 3,4a,and 4b. NOV 2 4 19900 following services(for an <br /> n Print your name and address on the reverse of this form so that we can return this extra fee): <br /> card to you. <br /> aAttach this form to the front of the mallpiece,or on the back if space does not <br /> 1. 0 Addressee's Address <br /> permit. <br /> a Write'Return Receipt Requested'on the mailpiece below the article number. 2. 0 Restricted Delivery <br /> .S a The Return Receipt will show to whom the article was delivered and the date W <br /> r delivered. Consult postmaster for fee. <br /> 0 a <br /> 3.Article Addressed to: 4a.Article Number 0 <br /> cc <br /> C <br /> ATTN FACILITY MANAGEMENT 4b.Service Type <br /> 41 <br /> LORI MEMORIAL HOSPITAL 0 Registered 0 Certified cc <br /> P 0 BOX 3004 0 Express Mail 0 Insured .5 <br /> ce <br /> LODI CA 95240 0 Return Receipt for Merchandise 0 COD <br /> 7.Date of Delivery 0 <br /> 5.Received tit Name) 8.Addressee's Address(Only if requested <br /> and fee is paid) <br /> Of <br /> 6.Signature:(Ad ssee o Agent)'�' <br /> X � 401A—oe— <br /> PS Form Al 1, December 1994 Domestic Return Receipt <br />