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<br />~ SENDER: <br />"'C - Complete items 1 and/or 2 for additional services. <br />'(jj - Complete items 3, 4a, and 4b. <br />:Jl - Print your name and address on the reverse of this form so that we can return this <br />:u card to you. <br />> -Attach this form to the front of the mailpiece, or on the back if space does not <br />~ permit. <br />-Write 'Return Receipt Requested' on the mailpiece below the article number. <br />-The Return Receipt will show to whom the article was delivered and the date <br />delivered. <br /> <br />I also wish to receive the <br />following services (for an <br />extra fee): <br /> <br />1. D Addressee's Address <br /> <br />2. D Restricted Delivery <br /> <br />Consult postmaster for fee. <br /> <br />4a. Article Number <br /> <br /> <br />8. Addressee's Address (Only if requested <br />and fee is paid) <br /> <br />CIl <br />;S <br /> <br />c <br />o <br />! 3. Article A~dressed to: J <br />i ~7?~/1~. 9L4~L ~7 <br />8 1i"ll (i:zt;,"Wt1o/ liud <br />en <br /> <br />~ 6/7z/J /-/;14) '/:7JA/ ~5lJdf <br /> <br />Cl <br />oct <br />z <br />a: <br />::J 5. Received By: (Print Name) <br />I- <br />w <br />a: <br /> <br />'" <br /> <br />:; <br />o <br />>- <br />.!!l <br /> <br />D Certified <br />D Insured <br />o <br /> <br />COD <br /> <br />CIi <br />o <br />.~ I <br />CIl <br />en <br />c.. <br />'Iii <br />o <br />CIl <br />0:: <br />c <br />.... <br />:J' <br />Qi <br />0::, <br />C'li <br />c <br />.c;; i <br />:J <br />.E <br />:J\ <br />g,1 <br />';':1 <br />c <br />l'll <br />.s::: <br />I- <br /> <br />Domestic Return Receipt <br /> <br />/9 <br />