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<br />,... <br />~ SENDER: <br />'';; . Complete items 1 end/or 2 for edditional services. <br />>> . Complete items 3, and 4a 80 b. <br />f . Print your name and address on the reve,se of this form so that we can <br />iD return this card to you. <br />;: . Attach this form to the front of the mail piece, or on the back If space <br />.- does not permit, <br />.:! . Write "Return Receipt Requested" on the mailpiece below the article number, <br />'oO . The Return Receipt will show to whom the article was delivered and the date <br />:5 delivered. <br />'g 3. Article Addressed to: <br />'D <br />'oO <br />iD <br />-IS. <br />IE <br />o <br />u <br />(,/) <br />(,r) <br />LLI <br />a: <br />Q <br />C~ <br />ct <br /> <br />01, fYl &1:r::d e I Y;:t!., <br />aJIn: t../ OWtJ..Jvd H et/.J vol <br />C/O C /o.,..k, 4- t'bmptJ.ny ~ <br />, 3 2 c) I ~b.,ft,w ~s t Ht!ewa.A ~~3 <br />Hob. s-k'1/ ~ 77 olf i) -lto'Z .~: <br /> <br />, j:f~ 8. <br /> <br /> <br />.! 5 <br />ICe . <br />j <br />I- <br />~~ 6. <br />o. <br />~ <br />C) <br />:.. PS Form 3811, December 1991 <br />J! <br /> <br />-AoU.S. GPO: t883-352.7t4 <br /> <br />I also wish to receive the <br />following services (for an extra 3 <br />fee): .~ <br />1. 0 Addressee's Address ~ <br /> <br />~ <br />';- <br />u <br />CD <br />II: <br />C <br />o. <br />::I <br />... <br />CD <br />o Insured _ II: <br />o COD ., C- <br />.; <br />~turn Receipt for ::I <br />Merchandise o. <br />7. Date of elivery .2 <br />t 3t '1 ! <br />Addressee's A dress (Only if requested ~ <br />and fee is paid) fa <br />.z:. <br />I- <br /> <br />2. 0 Restricted Delivery <br />Consult ostmaster for fee, <br />4a. Article. Number <br />? {{go {,-tlS- Z L/ <br />4b. Ser~;:, Type <br />o Regj~ed <br />lB-certiii~d <br />o Exprel/s- Mail <br /> <br />DOMESTIC RETURN RECEIPT <br />