RECEIVED

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SENDER:

COMPLETE THIS SECTION

COMPLETE THIS SECTION ON DELIVERY

•

Complefe items 1, 2, and 3. Also complete

A.

Signature

item 4

if Restricted Delivery is desired.

.

0

Agent

I

•

Print your’name and address on the reverse

X.~0

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.0

Addressee

so that we

can return the card to you.

B.

Received

by

(Printed

N~rme)

C~

Date

of Delivery

•

Attach this card to the back of the màilpiece,

.~

or on the front if:space permits.

~

‘.Q~

i~

,

D.

Is

delivery address differentftom itenil?

0

Yes

1.

Article.Addressed

to:

lOt

7iO4

B

.M.

/

If YES,’ enterdeHveryaddress beIow~

0

No

AC 2004—041

/

Cheryl Clayton

P.O. Box

5245

Quincy, IL 62305

-

3.

Service Type

$.Certlfied Mail

~

Express Mail.

0, Registered

0

Return Receipt for Merchandise

0

Insured Mail

0

D.O.D.

4.

Restricted

Delivery?

(Extra Fee)

0

Yes

2.

Article Number

ser?ro,nsen,IcelabeO

7002 0860 0004 9617 9922

PS

Form

3811,

Februia,y 2004

Dômèstio Return

Receipt

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