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■ Complete It Also complete <br />item 4 if R ri v is <br />■ Print your n t erse <br />so that we can re urn c <br />■ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />COUNTRYSIDE MINTNI MART <br />14971 N HWY 83 <br />LODI CA 95240 <br />A. Signature <br />Agent <br />❑ Addressee <br />B. R ceived b tinted Name) C. Date of Delivery <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Seice Type <br />Certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7004 2510 0003 3789 0658 <br />(transfer from service label <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 <br />