U N IVEBSAL POSTAL CON VEN TION -VIEN N A. JULY 4, 1891. I 149 AN NEXES. ’ , I" Form A ! Adevmiumtéam of . . ’ i { , RETURN RECEIPT. R“ mum I { { :n"i;;;ut:°!:;°::£€l:le }entered under No. ... , and gddmpsed to M .. at .. the . , _____,_,, 189.. The undersigned declares { :,]:2: ?$smbm%l° gto the above mentioned address. and originating at . hn been duly delivered on the ...,... 189. . Signature (*) Stems ofihe office of elivery. ‘ A of the addressee: of the chief of the office of delivery: / x ..»/
('> This Return Receipt must be eiguml by the ndalrvseee; or. if the regulations of the country of destination permit it, by the ehiel of the ulhcu nl dc-livery, then placed in un vuvelo re. nml trhxsmltted, under registration. by thu lh-sr mul tu the utiice of origin of the article to wlbich it IB tc!.
