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<br />e <br /> <br />e <br /> <br />f'" <br />.@ 5lENDEPt: <br />'c,j 0 Complete items 1 and/or 2 for additional services, <br />(') 0 Complete items 3, and 4a & b, <br />l'! 0 Print your name and address on the reverse of this form so that we can <br />~ return this card to you. <br />(9 0 Attach this form to the front of the mail piece, or on the back if space <br />'" does not permit, <br />2 0 Write "Return Receipt Requested" on the mailpiece below the article number. <br />"'" 0 The Return Receipt will show to whom the article was delivered and the date <br />6 delivered, <br /> <br />-g <br />(9 <br /><'" <br />(ll <br />1i <br />E <br />o <br />u <br />W <br />W <br />w <br />g <br />~ <br />o <br /><! <br /> <br />(E <br /> <br />I also wish to receive the <br />following services lfor an extra <br />fee): <br /> <br />1. 0 Addressee's Address <br /> <br />(1) <br />y <br />.::; <br />... <br />\!) <br />(/) <br /> <br />3. Article Addressed to: <br /> <br />4a, <br /> <br />2. 0 Restricted Delivery <br />Consult postmaster for fee. <br />Article Number <br />I & /)3 Cj <br /> <br />... <br />!:!. <br />'Qi <br />U <br />\!) <br />tl!: <br />c: <br />.. <br />:l <br />"" <br />\!) <br />t:il: <br /> <br />e!35 L , <br />o.Jin: lorn f/af1~ Pfesid~111: <br />ltanS l~ort~i(D~ (feru/ces <br />l/ 7<)0 S. JJJ ern W1tLlI/ ti.()eA')~ <br />th,"c.tt!j; T L 00& 38 <br />5. <br /> <br />P .J 80 <br /> <br />4b, Service Type <br />o Registered <br />l1J.-eertified <br /> <br />o Express Mail <br /> <br />o Insured .', <br />o COD _ <br />~urn Receipt for <br />Merchandise <br />7, Date of Deliv~ <br />I ,. ') 1'..-7-' <br />~ <br />8. Ad.I~,SSt;le's Address (Only if requested ~ <br />anol~ is paid) fij <br />r"J -; I ~ <br />) <br /> <br />t>l <br />r;: <br />'(/j <br />::l <br /> <br />... <br />(;) <br />~ <br /> <br />:l <br />o <br /> <br /> <br />'gnature (Addressee) <br />~-~ <br /> <br />Signature (Agent) <br /> <br />s <br />@ <br />>- PS Form 3~ 'TI '0, December 1991 t<U.S, GPO: 1993-352-714 DOMESTIC RETURN RcCEI~T <br />E <br />