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P 529 408 434 <br />RECEIP'T FOR CERTIFIED PU11AIL <br />NOINSURANCE COVERA6E PROVIDED <br />NOT FOR INTERNATIONAL MAIL <br />(See Reverse) <br />? sent to Mr. George Fabe <br />? <br />? <br />Street and No. ' <br />; 2100 Stella Court <br />o P.o., state and 19??IUMbus , 43266-0 <br />a <br />t7 Postage $ <br />Ed <br />? <br />* Certified Fee <br />Special Delivery Fee <br />Restricted Delivery Fee <br />Return Receipt Showing <br />to whom and Date Delivered <br />? Return receipt showing to whom, <br />im Date, and Address of Delivery <br />? TOTAL Postage and Fees $ <br />LL <br />o Postmark or Date <br />ao <br />M <br />E <br />O <br />LL <br />? <br />d <br />6 ' <br />N <br />? <br />0 <br />3 <br />? <br />J <br />? <br />` <br />c <br />< <br />jo SENDER: Cortaplete iterrn 1, 2, 3 and 4. <br />Put your address in the "RETU RN TO" space on the <br />reverse side. Failure to do this will prevent this card from - <br />being returned to you. The retum ceceipt fee will provide <br />you the namm of the pecson dolivaer¢d to and the date o1 <br />delivery. For edditiortal fees the following services are <br />aveilable_ CorLUlt oostmaster for 4est and check box(es) <br />for service(s) requested. <br />7. ? Show to whom, date and address of delivery. <br />2. ? Restricted Delivery. <br />3. Article Addressed to: <br />Mr. George Fabe <br />State Supt. of Insurance <br />2100 Stella Court <br />Columbus9 Zhio 43266-0566 <br />1 <br />4. Type of Service: Article Number <br />D Registered ? Insured P 529 408 434 <br />SM Certified ? COD <br />? Express Mail . <br />Always obtain signature ot addressee or agent and <br />D,4TE DELIVERED. <br />5. Signature - Addre3see . <br />X ,'., . <br />6. Signalure gent?, <br />X <br />7. Date;bf Delivery <br />' <br />s. Addr??s??z?da?? ?J?L• ; requesre Q ee paid) <br />t'1 <br />? <br />? <br />n <br />m <br />? <br />? <br />,?. <br />?•. <br />?