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' L r, I I uI <br /> C' SENDER: I also wish to receive the <br /> v ■Complete items 1 and/or 2 fo ditional service . (��� �ggg <br /> Z ■Complete items 3,4a,and 4b. v f011OWln services(for an <br /> G) ■Print your name and address on the reverse of this form so that we can return this extra fee). <br /> card to you. <br /> ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addre ee's Address <br /> permit. <br /> d ■Write-Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restri ed livery N <br /> .t. ■The Return Receipt will show to whom the article was delivered and the date a <br /> c delivered. Consult post aster for fee. F <br /> 0 <br /> 3.Article Addressed to: 4a.Article Nu b r (� w <br /> Z 1- � _C <br /> ° 4b.Service Type <br /> E USA GASOLINE 4835 �/ <br /> 30101 AGO <br /> CT STE 200 ❑ Registered L�'certified <br /> AGOURA HILLS CA 91301-4311 ❑ Express Mail ❑ Insured y <br /> ❑ Return Receipt for Merchandise ❑ COD <br /> 7.Date of D livery <br /> G). o <br /> 5.Received By:(Print Name) 8.Ad( ress 10 y if requested <br /> and fee is paid) t <br /> I— <br /> g 6.Signat e:( ddressee r g t) <br /> X <br /> a PS Form 5811, December 1994 Domestic Return Receipt <br />