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201207518 <br /> � . , . . . . . •'� <br /> r Complete items 1,2,and 3.Also complete A Signatui . . <br /> Item 4 If Restricted Delivery is desired. x �9� <br /> ■ Print your name and address on the reverse ���' ❑Addressae <br /> 5o that we can retum the Ca�d to y0u, g, b (Pnrrted N �e) C. Date of Detivery <br /> ■ Attach this card to the back of the mailpiece, �. <br /> or on the froM'rf space pertnits. � � �'jZ` <br /> D. Is de ry address diflerarrt ttem 11 ❑Yes <br /> 1. Akicla Addressed fo: <br /> If YES,anterdelivery address below: ❑ No <br /> lnternal Reve�nue Service—Technical Services <br /> Attn: Susan Miller <br /> f 616 Capitol St., Ste.440 � <br /> Omaha,NF,68]02 3. servme rype <br /> �Certhed Meil ❑Expiess Mail <br /> ❑Registered ❑Retum Recelpt for Merchendiae <br /> ❑insured Mall ❑GO.O. <br /> 4. Rastnctetl Delivery7(Exhe Fee) ❑yes <br /> ..__ . —_._- ._. . <br /> 2. �uuc�eNumear 7011 �470 ODQ2 55�3 6984 <br /> (rrans/er from servlcelabel) <br /> ; PS Form 3811, February 2004 Dortrestic Retum Receipt to25e5i+a.M-�sao <br /> ° o <br /> � a � a . <br /> � •. • <br /> 0-' <br /> � <br /> p � � ,� d�"� � � � � <br /> ill u <br /> u'I Poeta9e $ 50• ����,y/;SE 7SVj�B� <br /> ti CertlfletlFee s2.gs B$�Y ��, <br /> O ' 4� � <br /> Poa � , <br /> � Ratum Feraip4 Fea s2.35 d'8p � <br /> � (Endorsement ReqWretl) y� �,, <br /> � Rastnc[etlDelireryFee $O•p� ''�J�e»��� <br /> � (Endoreement Requirotl) <br /> 7 ,;, c,�^,� <br /> o ���Po�ae g�.�. Q ss.�s v 3 <br /> � <br /> � ���T� Internal Reveoue Service—Technica] Services <br /> o ���,��_No.:'"Attn: Susan Miller <br /> �`' waoea�,vo. 1616 Capitol St., Ste.440 <br /> Q�%��a-Z1�+ Omaha. NE 68102 <br />