Front:
SENDER: Complete items 1 and 2.
Add your address in the "RETURN TO" space on
reverse.
1. The following service is requested (check one).
Show to whom and date delivered......... 15¢
Show to whom, date, & address of delivery.. 35¢
DELIVER ONLY TO ADDRESSEE and
show to whom and date delivered........... 65¢
DELIVER ONLY TO ADDRESSEE and
show to whom, date, and address
delivery
of
85¢
HELENHAY BECK
281MAIN STI,
2. ARTICLE ADDRESSED TO/
NORWALK, CONN. O6851
3. ARTICLE DESCRIPTION:
REGISTERED NO.
CERTIFIED NO.
INSURED NO.
63423
(Always obtain signature of addressee or agent)
I have received the article described above.
SIGNATURE
4.
DATE OF DELIVERY
POSTMARK
5. ADDRESS (Complete only if requested)
6. UNABLE TO DELIVER BECAUSE:
CLERK'S
INITIALS
* GPO : 1974 O 527-803
PS Form 3811, Nov. 1973
RETURN RECEIPT, REGISTERED, INSURED AND CERTIFIED MAIL
Back:
UNITED STATES POSTAL SERVICE
OFFICIAL BUSINESS
PENALTY FOR PRIVATE
USE TO AVOID PAYMENT
OF POSTAGE, $300
U.S.MAIL
SENDER INSTRUCTIONS
Print your name, address, and ZIP Code in the space below.
• Complete items 1 and 2 on reverse side.
• Moisten gummed ends and attach to back of article.
RETURN
TO
EDWARD L. PECK
RR #1, BOX 292
Glen Carbon, III, 62034
