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PLEASE FURNISH SERVICE(S) INDICATED BY CHECKED BLOCK(S). <br />REQUIRED FEE(S) PAID, <br />®Show to whom, date and address Deliver ONLY <br />where delivered ❑ to addressee <br />KLGEIPT <br />Received the numbered article described below. <br />REGISTERED NO. SIGNATURE OR NAME OF ADDRESSEE (Must alwaj-s be filled in) <br />CERTIFIED NO. 1 � > 1 4 <br />700779 2 SIGN ATUR.EQ/FADDRESSEE'S AG NT,IFANY <br />INSURED NO. y J <br />DATE DELIVERED SHOW WHERE DELIVERED (o�7twj' <br />Cu�.AUG 18 1978 3 ��S , Si Y��l <br />055-16-71548-11 317-193 GP0 <br />