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RECEIPT FOR CERTIFIED MAIL-30c � <br /> 5[HT TU <br /> r.}� I � r� Y (� IVSTMAPN ' <br /> , <br /> � A �A,.��r�AE��I'7'�� �i(�� D �`Y`� ono�re '� <br /> � STPCET�HO HO. �I <br /> � .J/� / . ��-� il <br /> � , AiE,AN ZIP[ DE 'I <br /> Q � l/!. � ����' �� '. <br /> �,�A/ �o�,; J- I <br /> EXiRA SFqYICES FOq AUDIilOM1L fEE2 �� <br /> R�turn R�qlot I Deliv r fa <br /> Shou�a eo u�hom Shuwa to wfmn Add � I <br /> nd dele deee.nnd n c�rn .�ee On/)• <br /> 0 �eLvewd tloLverntl <br /> �y 10 f !ee ❑ 75t Iee � 50{'fea <br /> POD Porm 3E00 NO INSURANCE COVER�CE PROVIDED— (Ser ot6cr side <br /> M11ar.1966 NOT FOR INTERNATIONA� M�tL ) � <br /> L' <br /> PLEASE FURNiSH SERVICE(3) INDICATED BY CHECKEp BLOCK(�. <br /> REQUIRED PEE(Sj PpID. <br /> Show to whom, date and address Delfver ONLY <br /> where dellvered to addnssee <br /> RECEIPT <br /> R¢celved the riun:Lersd ortick dweribed Lrlour, <br /> RECISTERFA tip. SIpNAT11RE OR NFMEOF AUDRE$EE( it d�ooyt�Jl:�d Jq) � � <br /> QIIFE�70� �` __ n - � <br /> � ---=Lc <br /> . S�GN�TUIIEOFADUAESSEE'SAOEXi, ANY <br /> INSURED N0. ���` /�� <br /> DATE OELIY ��IIpM WHRE D LIVERED(ertl�if�rq�vtft� <br /> ���� � �� � �� <br /> Q��3 ,� <br /> �.`J�i-- � �/�n`� a60—te�lfeY.lt a�7-Ip aw <br /> 'T' <br /> I — . —' <br />