HomeMy WebLinkAbout13-6775 Supreme CO uTt UM Pennsylvania
CourtCofx mmon leas For Prothonotary Use Only:
Civil`Cov& Sheet
. Docket No: S
CUMBERLAND County
The inforniation collected on this is used solely for court administration purposes. This form sloes not
supplement or replace the f line and servile of l)leodin�gs or other papers as required 1))% IMI or rules of courl.
Commencement of Action:
S 0 Complaint El Writ of Summons ❑ Petition
Transfer from Another Jurisdiction ❑ Declaration of Taking
E
C Lead Plaintiff's Name: Lead Defendant's Name:
T Law Offices of Alan R. Mege Jennifer Rush
I Are money damages requested? El Yes ❑ No Dollar Amount Requested: Owithin arbitration limits
(check one) ❑outside arbitration limits
N Is this a Class Action Suit? ❑ Yes ix No Is this an MDJAppeal? ❑ Yes 0 No
A Name of Plaintiff /Appellant's Attorney: Alan R. Mege, Esq.
El Check here if you have no attorney (are a Self - .Represented [Pro Sej Litigant)
Nature of the Case Place an "X" to the left of the ONE case category that most accurately describes your
PRIMARY CASE. If you are making more than one type of claim, check the one that
you consider most important.
TORT (do not include Mass Tort) CONTRACT (do not include Judgments) CIVIL APPEALS
❑ Intentional ❑ Buyer Plaintiff Administrative Agencies
❑ Malicious Prosecution 0 Debt Collection: Credit Card ❑ Board of Assessment
Motor Vehicle ❑ Debt Collection: Other ❑ Board of Elections
❑ Nuisance ❑ Dept. of Transportation
.Premises Liability ❑ Statutory Appeal: Other
S ❑ Product Liability (does not include
[] Employment Dispute:
E mass sort)
Slander/L.ibel /Defamatioo Discrimination
El
C El Other: [3 Employment Dispute: Other El Zoning Board
T ❑ Other:
I ❑ Other:
O MASS TORT
❑ Asbestos
N ❑ Tobacco
Toxic Tort - DES
Toxic Tort - Implant REAL PROPERTY MISCELLANEOUS
Toxic Waste
n Other:❑ Ejectment ❑Common Law /Statutory Arbitration
B ❑ Eminent Domain /Condemnation ❑ Declaratory Judgment
Ground Rent ❑ Mandamus
Landlord /Tenant Dispute ❑ Non - Domestic Relations
Mortgage Foreclosure: Residential Restraining Order
PROFESSIONAL LIABLITY Q Warranto
El Mortgage Foreclosure: Commercial
Dental ❑ Partition ❑ Replevin
El Legal ❑ Quiet Title ❑ Other:
Medical ❑ Other:
Other Professional:
Updated 1/1/2011
v
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
LAW OFFICES OF ALAN R. MEGE,
Plaintiff No. 13- 075Civil Term
vs.
CIVIL ACTION
JENNIFER RUSH,
Defendant
NOTICE -<
YOU HAVE BEEN SUED IN COURT. IF YOU WISH TO DEFEND AGAINW_HF,—
CLAIMS SET FORTH IN THE FOLLOWING PAGES, YOU MUST TAKE ACTION '�a�IlIa1�
TWENTY (20) DAYS AFTER THIS COMPLAINT AND NOTICE ARE SERVED BY �4
ENTERING A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEYS AND
FILING IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE
CLAIMS SET FORTH AGAINST YOU. YOU ARE WARNED THAT IF YOU FAIL TO DO
SO, THE CASE MAY PROCEED WITHOUT YOU AND A JUDGMENT MAY BE
ENTERED AGAINST YOU BY THE COURT WITHOUT FURTHER NOTICE FOR ANY
MONEY CLAIMED IN THE COMPLAINT OR FOR ANY OTHER CLAIM OR RELIEF
REQUESTED BY THE PLAINTIFF. YOU MAY LOSE MONEY OR PROPERTY OR
OTHER RIGHTS IMPORTANT TO YOU.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
CUMBERLAND COUNTY BAR ASSOCIATION
2 LIBERTY AVENUE
CARLISLE, PA 17013
TELEPHONE (717) 249 -3166
an R. Mege, ?intiff
Attorney ID No288
Attorney for PI
Law Offices of Alan R. Mege, Esq.
P.O. Box 1426
Bethlehem, PA 18016 -1426
(610) 954 -5393 CIS
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
LAW OFFICES OF ALAN R. MEGE,
Plaintiff No. Civil Term
vs.
CIVIL ACTION
JENNIFER RUSH,
Defendant
COMPLAINT
1. The Plaintiff is Offices of Alan Mege. ( "Mege "), a proprietorship with an address
of 70 E. Broad St., Bethlehem, PA 18018.
2. The Defendant is Jennifer Rush, ( "Rush "), an individual with an address of 300
Carlton Rd., Charlottesville, VA 22902, previously residing at 1080 Creek Rd., Carlisle, PA 17015.
Count I - Breach of Contract
3. Defendant requested a credit card from Wells Fargo Bank, N.A., f /k/a Wachovia
Bank, when residing at 724 Alberta Ave., Mechanicsburg, PA 17050.
4. On June 9, 2008, Wells Fargo Bank, N.A., offered Defendant a revolving open -
end charge account and issued a card to the Defendant subject to the terms and conditions set forth
in a written agreement, a true and correct copy of which is attached hereto, made a part
marked as Exhibit "A ".
5. Exhibit "A ", the contract between the parties, is a written contract and is attached
hereto pursuant to Rule 1019(i).
6. Defendant accepted the terms of the written account agreement by using the Well
Fargo Bank credit card account number 4312- 4388 - 6278 -6933 for purchases, cash advances, and /or
balance transfers.
7. Defendant was mailed account statements relative to Defendant's use of the Wells
Fargo Bank credit card.
8. The Defendant has defaulted under the terms of the Agreement by failing to make
monthly payments as they became due and owing.
9. The last payment of the Defendant was received and credited on May 5, 2010.
10. The within account was sold by Wells Fargo Bank, N.A. to United Credit
Recovery of Sanford, Florida, ( "UCR ") for valuable consideration and all rights under said account
were assigned to UCR, whereupon UCR sold the within account for valuable consideration to Stride
Card, LLC ( "Stride "), whereupon Stride sold the within account for valuable consideration to
Fitzgerald Debt Acquisitions, LLC., ( "FDA ") for valuable consideration and all rights under said
account were assigned to FDA, whereupon FDA sold the within account for valuable consideration
to Mege and all rights under said account were assigned to Mege. A true and correct copy of the
Short Form Purchase Agreement, Short Form Purchase Agreement, Short Form Purchase Agreement
and Bill of Sale And Assignment are attached hereto, made a part hereof and marked collectively as
Exhibit "B ".
11. Pursuant to the terms of the Visa or MasterCard Account Agreement, Plaintiff,
upon default in payment, may declare the entire unpaid balance immediately due and payable without
notice or demand.
12. Pursuant to the terms of the Agreement, Defendant, is liable for interest on the
unpaid balance.
13. Pursuant to the terms of the Agreement, Defendant, is liable for Plaintiff's court
costs and reasonable attorneys fees.
2
14. As of July 31, 2010, the balance due and owing to Plaintiff from Defendant was
$6,321.42.
WHEREFORE, Plaintiff, requests judgment in its favor and against the Defendant,
in the amount of $6,321.42 plus costs and interest from July 31, 2010 as well as reasonable attorneys
fees of $750.00 and such other and further relief as the Court may deem just and appropriate.
Count II - Account Stated
15. Plaintiff incorporates the allegations of every paragraph enumerated above of
this Complaint as if said paragraphs were fully set forth here at length.
16. The within account was an account in writing and expressly or impliedly accepted
by both parties.
17. The amounts due and owing to Plaintiff by Defendant are based on a subsisting
debt and arise from a preexisting account or course of dealing between the parties.
18. This account is an Account Stated, thereby operating to foreclose any dispute
over the amounts due.
WHEREFORE, Plaintiff, requests judgment in its favor and against the Defendant,
in the amount of $6,321.42 plus costs and interest from July 31, 2010 as well as reasonable attorneys
fees of $750.00 and such other and further relief as the Court may deem just and appropriate.
Count III - Quantum Meruit
19. Plaintiff incorporates the allegations of every paragraph enumerated above of
this Complaint as if said paragraphs were fully set forth here at length.
20. The services provided by Plaintiff, by and through its predecessor in interest, and
same were received by the Defendant, and the Defendant received and accepted the benefit of said
services provided by Plaintiff.
3
21. At all times material hereto, Defendant was aware that Plaintiff by and through
its predecessor in interest, was providing the aforesaid services to Defendant and expected to be paid
for such.
22. At all times material hereto, Defendant, with the aforesaid knowledge,
permitted Plaintiff by and through its predecessor in interest, to provide the aforementioned services
and incur damages.
23. At all time material hereto, the Defendant was unjustly enriched by
retaining the benefit of receiving said services without paying Plaintiff or its predecessors fair and
reasonable compensation.
24. By reason of the aforesaid unjust enrichment of Defendant at Plaintiff's
expense, an implied contract exists between the Plaintiff and the Defendant, and the Defendant is
obligated to pay Plaintiff the value of the services described above and in the exhibits attached
hereto, in the amount of $6,321.42 plus costs and interest from July 31, 2010.
WHEREFORE, Plaintiff, requests judgment in its favor and against the Defendant,
in the amount of $6,321.42 plus costs and interest from July 31, 2010 as well as reasonable attorneys
fees of $750.00 and such other and further relief as the Court may deem just and appropriate.
By:
. Mege, Esqui
Atty. I.D. #81288
Attorney for Plaintiff
P.O. Box 1426
Bethlehem, PA 18016 -1426
(610) 954 -5393
4
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SHORT FORM PURCHASE AGREEMENT"
This Short Form Purchase Agreement ( "SF1'A ") is entered into this 22nd day of April,
2011 by and between United Credit Recovery of Sanford, Florida, as Buyer, and Welts
Fargo Ban.]<, N.A. as Seller.
Pursuant to the terms of a Purchase Agreement (the "Agreement ") executed by the
Parties and this SFPA, Buyer hereby purchases and accepts, and Seller hereby sells,
assigns, transfers, tu conveys to buyer, all its rights, interest and title in and to the
Receivables listed on the attached Schedule A. The Agreement is incorporated herein and
made a part hereof as if fully set forth. In the event of a conflict between the terms of this
Bill of Sale and those of the Agrecment, the terms of the Agreement shall prevail, All
terms defined in the Agreement shall have the same meaning as given in the Agreement
when used in this SFPA.
Seller: Wells Fargo Bank, N.A.
Buyer: United Credit Recovery of S mfbrd, Florida
Number of Receivables: 53,818
Outstanding Gross Balance of Receivables: $23,441,874.
List of Receivables transmitted to UCR on 04 /20/2011
Purchase Price:
Cut -Off Date: 04/22/11
Closing Date: 04/22/11
BUYER. SELLER,
UNITED CREDIT RECOVERY OF SANFORD, WELLS LARGO BANK, N.A.
FLORIDA
Fay: - -� _ _ _ N;Lit�t . 7 orlr LaCentra
Name: d��� 6 Title: EVP
Title:
G� /�vl.
' Il lov s
r,�rrin�rr �
SHORT FORM PURCHASE AGREEMENT
This Short Form Purchase Agreement ( "SFPA ") is entered into this May 4, 2011 by and
between United Credit Recovery of Sanford, Florida, as Seller, and Stride Card, LLC as
Buyer.
Pursuant to the terms of a Purchase Agreement (the "Agreement ") executed by the Parties
and this SFPA, Buyer hereby purchases and accepts, and Seller hereby sells, assigns,
transfers, and conveys to Buyer, all its rights, interest and title in and to the R_eceivablcs
listed on the attached Schedule A. The Agreement is incorporated herein and made a part
hereof as if fully set forth. In the event of a conflict between the terms of this Bill of Sale
and those of the Agreement, the terms of the Agreement shall prevail. All terms defined
in the Agreements all have the same meaning as given in the Agreement when used in
this SFPA.
Seller: United Credit Recovery
Buyer: Stride Card, LLC
Number of Receivables: 24,567
Outstanding Gross Balance of Receivables: $10,714,897.97
List of Receivables attached hereto as Schedule A
Purchase Price:
Cut -Off Date: May 6, 2011
Closing Date: May 6, 2011
SELLER BUYER
UNITED CREDIT ECOVERY STI D CARD, LLC
B y: L PM o-f-�1 t U I3 y: l �
Name: Name: kktch !" &cLi
Title: 1�,,ebiv, Title: �'
ASSIC.ivNIP"A I A:NO 1mll:fi O 5AL , PA C.E O N'I',
5I?LLF,R (hercinafl:er called "SOW) has cntcred into a Receivables Purchase
Agreement dated Away % 2013("Alrremum! ") for the We of Accounts on Exhibit "A" licrcol'
to Fitzgerald Debt A guillions, ITC (hcrchm ler AM "Purchaser" ), upon the onus and
conditions set 'forth in that Agreement.
NOW, 'I'I IE1ZC -TO1 1", for j.pod and valmlhle consideration, Seller hereby sells, assigns,
and transfers, whout recourse except as pmvided for in the Agreement, to Purchaser, its
successors and assigns, all of Seller's rif ;hts' title, and interest. in each and every 0110, of the
Accounts described in the Agreement and Purchaser assumes the obligotions and nuaemnilts as
relating to the accounts as relating to the Agreement.
Purchaser and Seller apse that the Purchase I'M ;hall be as stated in Section 2 and
I?zhM B of this Agreement.
IN WITN11.SS W14ERI OF, Seller has signed and delivered this instrument on 1/2.11:1
SELLER:
�TRlDl=:t
_..
tacyues A. 1�4irchol, Ill. �� ;ace
..rte/
i
• la Xt -t YI3I't' '� A"
BILL OF SALE AND ASSIGNMENT
KNOWN ALL MEN BY THESE PRLSI-NI'S, that the undersigned hereinafter Fitzgerald.
Debt Acquisitions, L referred to as "Assignor," for good and valuable consideration,
receipt of which is hereby acknowledged, does by these presents, assif;n, sell, transfer, convey,
and set over to Low Off , es of Alan Meye its successors and assigns, hereinafter refcrred to is
"Assignee," all of its rights, tide and interest in and to certain receivables, related documents
evidencinng security interest, liens or other security instruments or encurrnbrances executed, filed
and /or created in conjunction with said Accounts and all other rigliLs and documentation
ancillary to said Accounts. Such Accounts are described in the attached appendix and referred to
as Charged -Off Accounts in the RCCCIVabtCS P UrCInaSC and Sale Agreement ( "Agreement ")
executed by the parties hereto and dated Z, which Agreement is incorporated herein
and made a part hereof as if hilly set forth.
This Assignment is made without recourse or warranty except as otherwise provided in the
Agreement and other rights, privileges and documentation refcrred to herein and all its ternns and -
conditions are incorporated herein and made a part hereof as if fully set forth.
SELLER,
I
Seller initial_ Purchaser I nitiak/ ! q
i
NAME STREET CITY ST ZIP PHONE SOCIAL # ORIG CRED ACCOUNT #
11 PHILADELPHIA PA 19149 -0276 Wachovia
(► PHILADELPHIA PA 19130 -3017 dIqffENN* Wachovia
I7� ROYERSFORD PA 19468 -2966 44ANNOM Wachovia
LEESPORT PA 19533 -0493 Wachovia
LANCASTER PA 17602 Wachovia
EFFORT PA 18330 -9344 Wachovia 4�Iiw1�r
JENNIFER RUSH 1080 CREEK RD CARLISLE PA 17015 30111&3376 Wachovia 4312438862786933
TAMAQUA PA 18252 -5549 741111M Wachovia
PHILADELPHIA PA 19120 -1801 � Wachovia
KENNETT SQUA PA 19348 -2909 MUM Wachovia
ALLENTOWN PA 18103 -7435 ] Wachovia
PHILADELPHIA PA 19124 -0212 Wachovia
ALBURTIS PA 18011 -0145 Wachovia
AVONDALE PA 19311 Wachovia _
UPPER DARBY PA 19082 -3505 06ENNOW Wachovia
PHILADELPHIA PA 19140 -1017 Wachovia
NEW CUMBERL PA 17070 Wachovia
PHILADELPHIA PA 19136 -3335 Wachovia
COLLEGEVILLE PA 19426 -2907► Wells Fargo
60 PHILADELPHIA PA 19131 -2909 Wachovia _.
PITTSTON PA 18640 -2012 Wachovia
BETHLEHEM PA 18018 -5916 ! Wachovia
i
ORIG PRIN CURRENT PR1N INT RATE LAST PAY DTE OPENDATE CHGOFF ALT PHONE
$7,299.76 $7,299.76 6 11/10/2009 07/17/2009 06/30/2010
$16,703.56 $16,703.56 16 12/4/2009 08/24/2006 07/31/2010
$12,248.90 $12,248.90 6 1127/2009 01/02/2007 07/31/201
$7,550.45 $7,550.45 6 12/11/2009 08/21/2008 07/31/2010
$3,690.37 $3,690.37 17 4/13/2010 08/21/2006 07/31/2010
$13,795.57 $13,795.57 6 8/6/2010 07/04/2008 07/31/2010
$6,321.42 $6,321.42 10 5/5/2010 06/09/2008 07/31/2010
$3,289.46 $3,289.46 10 5/28/2010 09/13/2006 06/30/2010 �r�D
$2,179.10 $2,179.10 12 6/4/2010 09/02/2008 07/31/2010
$3,272.46 $3,272.46 17 7/30/2010 02/19/2008 05/31/2010
$7,152.80 $7,152.80 7 12/8/2009 02/02/2009 07/31/2010
$5,495.80 $5,495.80 7 1/11/2010 03/21/2008 08/31/2010
$6,207.22 $6,207.22 7 2/26/2010 04/18/2008 08/31/2010
$2,944.71 $2,944.71 6 3/5/2010 07/14/2009 08/31/2010
$5,386.71 $5,386.71 10 4/11/2010 01/18/2008 09/30/2010
$623.19 $623.19 14 2/24/2010 08/25/2009 09/30/2010
$654.12 $654.12 10 8/30/2010 05/13/2008 09/30/2010
$3,321.04 $3,321.04 14 5/14/2010 04/02/2007 01/31/2011
$997.89 $997.89 23 7/19/2010 09/22/2009 08/12/2010
$6,817.22 $6,817.22 14 10/31/2010 08/05/2009 11/30/2010
$8,446.74 $8,446.74 6 3/31/2011 10/13/2006 05/31/2010.
$16,472.59 $16,472.59 6 9/6/2010 08/15/2006 01/31/2011
1
VERIFICATION
I, Alan R. Mege, Plaintiff herein, do hereby verify that I am the keeper of records
of the Plaintiff in the foregoing civil action and that I am fully authorized to make this
verification and that the facts set forth in the Complaint are true and correct to the best of my
knowledge, information, and belief.
Verifier understands that false statements herein are made subject to the penalties
of 18 Pa. C.S.A.§ 4904, relating to unsworn falsification to authorities.
Date: 11/5/13 _
n R. Mege
SHERIFF'S OFFICE OF CUMBERLAND COUNTY,
Ronny R Anderson
Sheriff
Jody S Smith .Gk��e i a«iat w, , ar'
Chief Deputy 'c
Richard W Stewart --
Solicitor - ;, r
Law Offices of Alan R Mege Case Number
vs.
Jennifer Rush 2013-6775
SHERIFF'S RETURN OF SERVICE
11/18/2013 Ronny R Anderson, Sheriff, who being duly sworn according to law, states that he served the within
Complaint&Notice upon the within named defendant, Jennifer Rush, in the following manner: On
November 18, 2013 the Sheriff mailed by certified mail, return receipt requested a true and correct copy
of the within Complaint& Notice to the defendant's last known address of 300 Carlton Road,
Charlottesville, VA 22902. The certified mail return receipt card was received by the Cumberland County
Sheriffs Office Unclaimed by defendant.
11/18/2013 Ronny R Anderson, Sheriff, who being duly sworn according to law, states that he served the within
Complaint& Notice upon the within named defendant, Jennifer Rush, in the following manner: On
November 18, 2013 the Sheriff mailed by certified mail, return receipt requested a true and correct copy
of the within Complaint&Notice to the defendant's last known address of 109 Danbury Court,
Charolettesville, VA 22902. The certified mail was returned by the USPS marked"Return to Sender, Not
Deliverable as Addressed, Unable to Forward".
SHERIFF COST: $61.02 SO ANSWERS,
December 30, 2013 RONNW ANDERSON, SHERIFF
liggrANITTIFIEDAVALWNDZOW
III I 11 111 1111 11111 lid S P ...OSTACrE>';:-PITi,EY SO,,:ES
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of The She 7007 0710 0003 2210 4884 FSEAsoN ts
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ennsylvania 17013 77...------
order Expinid
0 Unable TO FOrWant —
CI Atternple4.Not
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0 askew
a ft&eh stem ono awl
Jennifer Rush si;
.vt...—
300 Carlton Road -
Charlottesville,VA 22902
.... --'''''7--
----
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY 1
• Complete items 1,2,and 3.Also complete A. Signature i
item 4 if Restricted Delivery is desired.
0 Agent
r Print your name and address on the reverse X 0 Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
• Attach this card to the back of the mailpiece, I ,
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from item 1? 0 Yes
If YES,enter delivery address below: 0 No
Jennifer Rush
300 Carlton Road . 0 I. — (0 (Pm
A
Charlottesville, VA 22902
• __,..,._ ____ - 0 Certified Mali 0 Express Mall I
,
0 Registered 0 Return Receipt for Merchandise 1
0 insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Ardcle Number P '
(Transfer from service label) 7007 0710 0003 2210 4884
i PS Form 3811,February 2004
Domestic Return Receipt
102595-02-M-1540
._,
. -
•{A;A?
ilt,7011..al, le,1%,41,:" :4.1.: US POSTAG'' _,
I 1 ,1 1 1 1 1 1 III 1 I I 1
OF CUMBERLAN 7007 0710 0003 2210 4891
of The Sherift siU
17013 t "n'''
Ise Square, Rm. 303 _ _.. .. 02 1 n ''.9 0.5 1°
0001368848N0V 20 2013
)ennsylvania 17013
Jennifer Rush
109 Danbury Court
Charlottes,-:11" D A 9?Qn9
:r. .a.-
t
NI(IT 13 l-Ri El Tkiait-ItIlls P4'Ti.5!, SENDER
i
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*1 '773-451-,70174—'7A_4a i.
se=7.752.0E12"VP-z1Vi i.li.ii.it.t.t.,N.tiiiin.yl.ii1,74„!..1.11)1j, 1
p" 'CHI"
- -- -
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....' ."". ji4-01;1147"
"n H.LOClaid1113AN3ACidal.I.V kr5M01.1333r1d
-.,-,----- -
COMPLETE THIS SECTION ON DELIVERY
SENDER: COMPLETE THIS SEC I
t
k signature I
. 1
• Complete items 1,2,and 3.Also complete 0 Agent I
1 item 4 if Restricted Delivery is desired. X 0 Addressee 1
-- - a Print yourname and address on the reverse 1
C.Date of Delivery
I so that Vie can return the card to-you.. . ...13-Sec_e_lved by(Printed Name)
• Attach this card to the back of the matlprece, ,--
or on thE)front if space permits.
D. Is delivery address different from Item 1? 0 Yes
1. Article Addressed to: If YES,enter delivery address below: 0 No I
i
1
Jennifer Rush 3 it A
Am 1
„....
109 Danbury Court 3. Service Type I
Charlottesville, PA 22902
CI Certified Mail 0 Expnass Mall
- 0 Registered 0 Return Receipt for Merchandise 1
0 Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes t
2. Article Number - 7007 0710 0003 2210 4891
(Fransfer from service/abet) _
102595-0240-1540
PS Form 3811,February 2004 Domestic Retum Receipt ___ ____—_,