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111WAI CIkf t <br />a <br />• P T TI <br />TION <br />•1 P <br />i• 12p <br />A. Signature:, (O Add o -5 . 1ai-it <br />E0: <br />tiftig ;Jay <br />CERTIFIED M <br />■ Ensure Items 1, 2, and 3 are completed. <br />• Attach this card to the back of the malipiece, or on <br />the front if space permits. <br />X <br />B. Received By: (Printed Name) <br />-t^.• ISA .4 '1 <br />1. Article Addressed to: <br />MICHAEL R DARWIN <br />107 E A Street <br />Hastings NE 68901-6202 <br />ilii <br />1 <br />1111111111111111 <br />9490 9118 9956-0608 8902 90 <br />2. Article Number (Transfer from service label) <br />9414 7118 9956 0608 8902 03 <br />AISS <br />PS Form 3811 Facsimile, f Iy-1 S'ISDt: )" <br />111 <br />D.Is delivery address different from item 1? 0Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service 7y <br />0 � \ 7* <br />�F JL <br />� <br />� i . Lam. c 12 '1' / .L. -t., + <br />/j r�c� RE N TO SENDER <br />'Y `UNL-AlT1tU <br />isciiiBi-'c TO 'r uRwAisv <br />1tt1111t1111t11i111fl11flliItII 11111ijit11111t1111►illitliilltii <br />Certlfle <br />V <br />1 <br />$6.800 <br />US POSTAGE <br />FIRST-CLASS <br />FROMO686800 6 <br />stamps <br />111111111111 <br />9414 7118 9956 0608 8902 03 <br />1 <br />ssssos000szso <br />ama <br />uu <br />1 <br />tigg06TOZ <br />