- •
Complete items
1, 2,
and
3.
- Also
complete
item 4
if Restricted
Deilvery is
desired.
- • Attach
this card to the back
of
the
mailpiece,
or on
the
front
if
space
permits.
- 5414
Hill Road,
Ste.
- 382
Richmond,
IL 60071
I
A.
- Sig
D
Agent
x
l Addressee
,Y4eived by (Printed Name) C. Date of Delivery
D.
Is
delivery address different from item 1?
EJ
Yes
IfYES, enter delivery address below:
D
No
3.
Service Type
..Certified Mail
C Registered
C Insured
Mail
SENDER:
COMPLETE THIS SECTION
ii
PS
Form 3811,February
2004
O
Express
Mail
O
Return Receipt for Merchandise
o C.O.D.
4.
Restricted Delivery?
PCB 11-88,071613 GrnCrd 
