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SENDER: a s Ms to receive the follow- x 552 510 992 <br /> w a Complete Items 1 andlor 2 for additional services. Ing services(for an extra fee): <br /> a Complete items 3.4a,and 4b. <br /> ;n o Print your name and address on the reverse of this form so that we can return this t US Postal Service <br /> > caro to you. 1. ❑Addressee's Address Receipt for Certified Mail <br /> m o Attach this form to the front of the mailpiece,or on the back If space does not <br /> m permit. 2• ® Restricted Delivery _ No insurance Coverage Provided. <br /> e o write'Return Receipt Requested*on the met piece below the article number. DO not use for International MaliSee <br /> E3 The Return Receipt will show to whom the article was delivered and the date f] reverse) <br /> S <br /> p delivered. <br /> a 3.Article Addressed to: 4a.Article Number Street&Pkirrteer <br /> a; C , t <br /> CL JGtin(�Yle Jam' .Q.136►C ill 11101 `� <br /> E 4b.Service Type Post Office,State,&ziP Code <br /> ' v C&Kt d-t V#LfleUt-�,tif -;�V1/l�d5l� ❑Registered ertified �: Lvd i A LjS'1 1--ASO/ <br /> In <br /> W �, (3(})( a*foo d 0 ❑Express Mail ❑Insured N Postage <br /> Q i � t CA �Sa'`'^ ��v� ❑Return Receipt for Merchandise ❑COD w <br /> CrU tt 't g Certified Fee , <br /> a 7.D D <br /> of eliv ry <br /> >+ . Special Delivery Fee <br /> 5.Received By:(Print Name) 8.Addressee's Address(Only if reqbested and c <br /> ¢ fee is paid) Restricted Delivery Fee <br /> 6.Sign re(Addresse r Agent) Return Receipt Showing to <br /> °� " whom&Date Delivered <br /> PS Form 3811,December 19 102595-9e-8-0223 Domestic Return Receipt ¢ Date, t <br /> j W _��� 0 TOTAL Fees <br /> M P or Date <br /> € . Cn <br /> !L , <br /> J�-�n Stick postage stamps to article to cover First-Class postage,certified maiolee, <br /> f/ /C� <br /> /47-C S� V j �} charges for any selected optional services(See tront).ostmarked stick the ummed stub to the rp� 1.if you want this receipt p 9 <br /> �j /V X { .®, address leaving the receipt attached, and present the article at a post office service <br /> /� window or hand it to your rural carrier(no extra charge). <br /> t 2. It you do not want this receipt postmarked,stick the gummed stub to the right of the <br /> return address of the article,date,detach,and retain the receipt,and mail the article. <br /> I t 3. If you want apretum receipt,write the certified mail number and your name and address <br /> oCf) on a return receipt card,Form 3811,and attach it to the front of the article by means of the <br /> \ X0 S UI 2 O gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article <br /> P O dIZ PUL `ssaappn '9weu anon(fuud ® RETURN RECEIPT REQUESTED adjacent to the number. <br /> 4. It you want delivery restricted to the addressee, or to an authorized agent of the <br /> O1dirt7Sad _...__ <br /> Roe <br /> addressee,endorse RESTRICTED DELIVERY on the front of the article. <br /> plt?d seed V e6e3sOd 5. Enter fees for the services requested in the appropriate spaces on the front of this <br /> 1119V4 SselO lsil301AF13$l d1SOd S3receipt. It return receipt is requested,check the applicable blocks in item 1 of Form 3811. <br /> 6. Save this receipt and present it if you make an inquiry. 102595-98-a-P005 <br />