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Chapter t6. Al, tle!e 16.4§, ~o~ 1~.45.0S~t,
~ c~e~ed to the ~i~ z~er, Would you ~l~~k your
~ to v~ that ~ s~m~e(~) i~ ~v i~ not ~d
o~ ~e~ds ~ ~. ~, th~ofor~, ~u~t y~ ~e~ any and
You r~u~t/vpply fo~ a ~~n ~rmtt ~c~ the pe~tt o~e~ for the
RECEIPT FOR CERTIFIED MAIL--30~ (plus postage)
SENT TO POSTMARK
OR DATE
STREET AND NO.
P.O., STATE AND ZIP CODE
OPTIONAL SERVICES FOR ADDITIONAL FEES
RETURN k. 1. * Shows to whom and date delivered ........... 15¢
With delivery to addressee only ............ 65¢
RECEIPT 2. Shows to whom, date ~nd where deliveYed .. 35~
SERVICES With delivery to aadressee only ............ 85¢
DELIVER TO ADDRESSEE ONLY ............................................ : ......... 50d
SPECIAL DELIVERY (extro fee required) ...................................
PS Form NO INSURANCE COVERAGE PROVIDED-- (See other
Apr. 1971 3800
NOT FOR INTERNATIONAL MAIL
DYE TEST
Tax Code:
Mailing
.
Property Address.*._,
Subdivision;
DYE TEST:
[] Pos/five
~Negative
ADDI TI__ONAI- INFORMATION;
Offic~: ~
Field: