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+ <br /> - , <br />~' SENDER: <br />v ^comqete nems ~ and~or 2 tor additionai servicee. I also wish to receive the <br /> <br />m <br />^comp~ete items a, aa, ana at. <br />following services (for an ~ <br />~ ^ Print your name and address on the reverse of this fortn so that we can retum this e~ra fee): <br />' <br />~ <br />` card to you. <br />^~~ this fortn to the 6orrt of the mailpiece, w on the back if <br />space doea not ~,^ Add~eSSee's AddfeSS ~ <br />f <br />Z <br /> <br />d ^Write'Retum Recei t R uested' on ihe mail ece below the <br />P e4 a aRide number. <br />2. ^ Restricted Delivery m <br />N <br />~ ^The Retum Receipt will show to whom the artide was delivered and the date <br /> <br />o <br />deuverea• <br />Consult postmaster for fee. a <br /> <br />m <br />3. Article Addressed to: <br />4a. Article Number ~+ <br />~i <br />« ~ <br />°-' CURTIS COMSTOCR 782145 ~ <br />~ <br />a <br />~ 5 6 3 COURT STREET NE # 3 4b. Service Type m <br />~ SALEM OR 9 7 3 01 ^ Registered ~~ertified ~ <br /> ^ Express Mail ^ Insured ~ <br /> <br />^ Retum Receipt for Merohandise O COD ~ <br />' <br /> <br />7. Date of Delivery ~ <br />w <br /> **P528201247** o <br /> ~ <br /> 5. Received By: (Print Name) 8. Addressee's Address (Only if requested ~ <br /> and fee is paid) r <br /> f- <br />!.I .:1 ~! .J.. 4~ ~ 1;.J i~ ( I Agent) I <br />~I ~1 c1 ~! _-1 ~ 0 t. ~! ;~:i i l.L ~~i ,~ ~ ssa Domestic Return Receipt ~ <br />