- COMPLETETHIS SECTION
ON DELIVERY
A.
- Signature
X
DAgent
/cy-r74’I
ID2.o1.—--2 Addressee
Recei’ 5 e by (Printed
Name) C.
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Delive
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D.
- Is delivery address different from item 1?
D Ye
If YES, enter delivery
address
below: U
No
3.
- ServiceType
ertifled Mail
U ExpressMail
Registered
C
Return Receipt for
Merchandise
C InsuredMail
C COD.
- I Print your name and address on the reverse
so that we can return the card to you. A
1. Article Addressed to:
7/11/13
B.M.
AC 2013—044hz
Raymond Burns
117 Vine Stieet
P.O. Box 596
Sandoval, IL 62882
/
PS Form 3811, February 2004
4. Restricted Delivery?
AC 13-44,071913 GrnCrd 
