COMPLETE THIS SECTION ON DELIVERYComplete items 1, 2, and 3.
Also complete
item 4 if Restricted Delivery is desired.
Attach this card to the back of the mailpiece.
Washington, DC 20001
9/20/12 B.M.
A.
Signature
D Agent □ AddresseeB. Raceiyed by ( Printed Name) k eliveryD. Is delivery address different from item 1If YES. (Extra Fee) D Yes2. Article Number(Transfer from service label) 7011 0U0 0001 8270 2021PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Allowed
Adobe Portable Document Format (.pdf) - application/pdf
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