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<br />SENDER: <br />_ Complete items 1 andlor 2 for additional services. <br />- Complete items 3, 4a, and 4b. <br />_ Print your name 'and address on the reverse of this form so that we can return this <br />card to you. <br />- Attach this fonm to the front of the mailpiece, or on the back if space does not <br />permit. <br />-Write "Return Receipt Requested" on the mail piece below the article number. <br />-The Return Receipt will show to whom the article was delivered and the date <br />delivered. <br /> <br />3. Article Addressed to: <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. 0 Restricted Delivery <br /> <br />Consult postmaster for fee. <br /> <br />4a. Article Number <br /> <br />IJJ:" & Hrs" Jesse Lange <br />7048 Cottonwood Court <br />Centerville, till 55038 <br /> <br /> <br />5197 2837 <br /> <br />/' <br />~...gertified <br />o Insured <br />o COD <br /> <br />ai <br />.~I <br />~I <br />ell <br />en <br />c.. <br />oa:; I <br />U <br />ell <br />0: <br />E <br />::l <br />a; <br />0:' <br />01' <br />t:l <br /> <br />.~ I <br />.E' <br /> <br />~! <br />>- <br />-,,' <br />iii' <br />~I <br /> <br />5. Received By: (Print Name) <br /> <br />r to <br />(Only if requested <br /> <br /> <br />Domestic Return Receipt <br /> <br />;v <br />