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® SENDER: Complete items 1, 2, and 3. <br />Add your address in the "RETURN TO" space on <br />reverse. <br />1. The following; service is requested (check one). <br />Show to whom and date delivered .........._fi <br />Show to whom, date, and address of delivery <br />RESTRICTED DELIVERY <br />Show to whom and date delivered ..... ....._C <br />? RESTRICTED DELIVERY. <br />Show to whom, date, and address of delivery, $- , <br />(CONSULT POSTMASTER FOR FEES) . <br />2. ARTICLE ADDRESSED TO: <br />Doug Dokter <br />1366 - 108th Avenue North <br />Blaine, Minnesota 55434 <br />3. ARTICLE DESCRIPTION: <br />REGISTERED NO. CERTIFIED NO. INSURED NO. <br />928935 <br />(Always obtain signature of addressee or agtn. <br />I have received the article described above: <br />SIGNATURE -[j Addresser ? Authorized agent <br /> <br />4. <br />DATE OF DELIVERY ?rOSTWA'R O <br /> <br />5. ADDRESS (Corn fete only it requested) ti? I <br /> <br />6. UNABLE TO DELIVER BECAUSE: CLERK'S <br /> INITIALS <br /> <br />ti?, GPO: 1979-272-382