ORIGANft~.
‘6~k~K~
OFFW~E
~UG
2 32005
STATE OF
po~tut~Ofl
C~
SENDER:
COMPLETE THIS
SECTION
•
Complete items
1,
2. and
3. Also complete
item 4 if Restricted
Delivery is desired.
•
Print your name and address on the reverse
so that
we can
return the card to you.
•
Attach this card to the back
of the rnailpiece,
or o~pefront if space permits.
1.
Artl~dressedto:
8118/05
B.M.
AC.it.5—077
Hu~~carrard
14#4~North2040th Street
Flat~~~~
Rock,
IL 62427
/
B.
~ceived by
(PrintS
Name)
C~
Date of Delivery
/
“a
Is
delivery address different from
toni 1?
0
Yes
If Y~S.
enter delivery
address below:
C
No
3.
ServIce Type
ifled Mail
0
Express Mail
Re~stered
0
Return Receipt
for Merchandise
C
Insured Mail
0
COD.
4.
Restricted Delivery?
(Extra
Pee)
2.
ArtIcle Number
(flanster from
service
Jabs!)
7004
2890
0004
2307
1568
Si~a~ure
/2 /~/~
c~’niø~,
(
.(/W1~
0
Addre~ee
C
Yes
PS Form
3811,
February 2004
Domestic Return
Receipt
1025ti5-02-M-1540