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p 86R 541 170 <br />� Certified Mail Receipt <br />✓ No Insurence Coverage ProviAed <br />_ Do nat use for Inlemational Mail <br />s�i✓�������� <br />s�w <br />W <br />� Ralum P�ceNI 5iw+n�p ro WMm. <br />� ON�. 6 MEross d OelNary <br />� RIf11LPoflsus <br />ON� <br />EI �I <br />li <br />N <br />a <br />. . . . : , . . _ _ .. . . . .. _ , _. <br />' - -.r, .,.,����.�.......�... . ....�.. - itlonsl aervices. .� , � elso � wish to� receive: the-- <br />."C;•'ComD�ata itema 3, a�M 4e 6 b. '�.-_. -- followinp serviees (for m 6xtre "" � <br />�����Pont your neme and eddrass on tha mverae of this form so teel: � -� -� : " <br />- � ' :Fh�t ws e�n rcturn thia cerd to you. - � � � ' � �. ❑ Addressaa's Addresa_,.' _? <br />_ _Attach this form to the iron4ol�the_mailpieca, or o4the,:�.- - _ - _ . <br />."'`" beck if apace does not permit � � � � - � �� � � � �" <br />��� � Wdta "Returri Receipt Requested" on the mailpiece next ro Z• � Reatricted Deiivery ,� .. <br />� the �nicle nunlber. Consutt ostmester for tea. ' <br />3. Anicle Addressed to .-. c, . • 4e. Ap,lcle Number _ :�� � <br />�� /y) � .. /� . �i . . . . <br />���"�"/ �/ ' �Q (-i! 4b. Service Type � , <br />❑ Registered e � Insurod � K��;, <br />� ��53 I — y��:S�`.� � . , ,ad �-o �� <br />�" ` �� � Remm Hecef � <br />❑ Ezpress Meil ❑ Gt lor � <br />�-/��� ', l Merchandise <br />.. _ , � � `� J 7. Date of DJeliv ry � ) . <br />/1 ( <br />�� 5. Signeture (Addresseel � 8. Addressee's Addross 10n1y if requested <br />- � � and tee is oaidl � <br />PS <br />sso du.s.oro:two-.mant DOMESTIC RETURN RECEIPT <br />