25A-064 COMPLETE SECTION • s • DELIVERY
• Complete items 1,2,and 3.Also complete A. Signa e
item 4 if�iestricted Delivery is desired. �j�❑Agent
• Print yo!Ir name and address on the reverse �— ❑Addressee
so that./we can return the card to you. B. Received by(Printed Name) C.,44; f�Delivery
• Attachi"this card to the back of the mailpiece, r `1'61 of /U14!%^
or 'the front if space permits. _ �1 l
D. Is delivery address erent from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑ No
Florence £ lanette Palmquist ?,
P 0 Box 313
Hadley MA 01035
3. Service Type
•Certified Mail ❑ Express Mail
• Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
z. Number 7004 11,60 0005 0270 9268
(Transfer from se
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
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C3 $
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C3 Certified Fee p,Qst Ic.y'
C3 } Me
E3 Return Reciept Fee r A] , G�
(Endorsement Required) ( 26 �
C3 (�^^
,!] Restricted Delivery Fee 2r
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� (Endorsement Required) +.�...-�.
17-1 Total Postage&Fees
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E3Sent To Florence £ Lanette Palmq----------------------------------
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