HomeMy WebLinkAbout02-3273PAUL F. PASSARELLA, : IN THE COURT OF COI~ON PLEAS
PLAINTIFF : C~ COUNT"~, PENNSYLVANIA
SANDRA J. PASSAI~ELLA, : IN DIVORCE
DE~'mRDAITT :
NOTICE TO DEFEND AND CLAIM RIGHTS
YOU HAVE BEEN SUED IN COURT. If you wish to defend against
the claims set forth in the following pages, you must take prompt
action. You are warned that if you fail to do so, the case may
proceed without you and a decree of divorce or annulment may be
entered against you by the Court. A judgment may also be entered
against you for any other claim or relief requested in these papers
by the Plaintiff. You may lose money or property or other rights
important to you, including custody or visitation of your children.
When the ground for is indignities or irretrievable breakdown
of the marriage, you may request marriage counseling. A list of
marriage counselors is available in the Court Administrator,s
Office, Fourth floor, Cumberland County Courthouse, Hanover and
High Streets, Carlisle, Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY,
LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED,
YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM.
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.
Lawyer Referral Service
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
1-800-990-9108
PAUL F. PASSARELLA, : IN THE COURT OF CO~ON pT.m.~S
PLAINTIFF : C~ COUNTY, PENNSI~LVANiA
S~RA J. PASS~LLA, : IN DIVORCE
DEFENDANT :
COMPLAINT UNDER SECTION 3301 (c) OR
3301 (d) OF TEE DIVORCE CODE IN DIVORCE
1. The Plaintiff is Paul F. Passarella who resides at 106
Harlech, Williamsburg, Virginia 23188.
2. The Defendant is Sandra J. Passarella who resides at 38
Nathan Drive, Enola, Cumberland County, Pennsylvania 17025.
3. The Defendant has been a bonafide resident of the
Coramonwealth of Pennsylvania for at least six months immediately
prior to the filing of this Complaint.
4. The Plaintiff and Defendant were married on October 21,
1983 in Mechanicsburg, Cumberland County, Pennsylvania.
5. The parties have been living separate and apart since on
or about April 5, 2000.
6. There have been no prior actions of divorce or annulment
between the parties in this or any other jurisdiction.
7. The marriage is irretrievably broken.
8. There were where two children born of this marriage,
Diana Marie Passarella, DOB 09/26/1984 and Jason Daniel Passarella,
DOB 09/25/1986.
9. The Defendant is not a member of the Armed Services of
the United States or any of its Allies.
10. The Plaintiff has been advised
counseling and
the Court
10.
divorce.
of the availability of
that Plaintiff may have the right to request that
require the parties to participate in counseling.
Plaintiff requests the court to enter a decree of
Thomas D. Gould
Attorney for Plaintiff
I.D. # 36508
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
VERIFICATION
I verify that the statements made in this Complaint are true
and correct. I understand that false statements herein are made
subject to the penalties of 18 Pa. C.S. 4904, relating to unsworn
falsification to authorities.
Date:
/ Paul F. B~ssarelia
PAUL F. PASSARF?.?.~, :
PLAINTIFF :
:
v. : NO. 0~- ~3
:
SANDRA J. PASSAR~T.T.~, : IN DIVORCE
DEFENDANT :
IN THE COURT OF CO~ON PLEAS
C%R~BEBLAND COUNTY, PE~SYLVANIA
NOTICE TO THE DEFENDANT
If you wish to deny any of the statements set forth in this
affidavit, you must file a counter-affidavit within twenty days
after this affidavit has been served on you or the statements will
be admitted.
PLAINTIFF'S AFFIDAVIT UNDER
SECTION 3301(d) OF THE
DIVORCE CODE
1. The parties to this action separated on or about April 5,
2000 and have continued to live separate and apart for a period of
at least two years.
2. The marriage is irretrievably broken.
3. I understand that I may lose rights concerning alimony,
division of property, lawyer's fees or expenses if I do not claim
them before a divorce is granted.
I verify that the
and correct. I understand that
subject to the penalties of 18
falsification to authorities.
Date:
statements made in this affidavit are true
false statements herein are made
Pa.C.S. 4904 relating to unsworn
PAUL F. PASSARELLA,
PLAINTIFF
Vo
SANDRA J. PASSARELLA,
DE~'mNDANT
IN THE COURT OF C0~ION P?.~.~S
~ COUNTY, PENNSYLVANIA
NO. 02-3273 CIVIL TERM
IN DIVORCE
AFFIDAVIT OF SERVICE
I, Thomas D.
captioned action for
Notice of Intention
Gould, attorney for Plaintiff, in the above
divorce, hereby certify that Plaintiff's
To Request Entry of Divorce Decree and
Defendant's Counter-Affidavit Under Section 3301(d) of the Divorce
Code was served upon the Defendant by depositing the same in the
United States mail, first class, postage pre-paid on August 5,
2002, to her attorney, John F. King, 600 North Second Street,
Harrisburg, Pennsylvania.
Thomas D. Gould
ID # 36508
Attorney At Law
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
PAUL F. PASSARELLA,
PLAINTIFF
Vo
SANDRA J. PASSARE?.?J%,
DE~TDANT
IN THE COURT OF CO~N PT.~.~S
C~4BERLAND COUNTY, PENNSXLVANIA
NO. 02-3273 CIVIL
IN DIVORCE
NOTICE OF INTENTION TO REQUEST ENTRY OF DIVORCE DECREE
TO: SANDRA J. PASSARELLA:
PAUL F. PASSAB~T.T.~ intends to file with the court the attached
Praecipe to Transmit Record on or after August 26, 2002 requesting
that a final decree in divorce be entered.
Thomas D. Gould
Attorney for Plaintiff
PAUL F. PASSARELLA,
PLAINTIFF
SANDRA J. PASSARELLA,
D~-~'mNDANT
IN THE COURT OF CO~40N PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 02-3273 CIVIL
IN DIVORCE
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Transmit the record, together with the following information,
to the Court for the entry of a divorce decree:
1. Ground for divorce: irretrievable breakdown under Section
3301(d) (1) of the Divorce Code.
2. Date and manner of service of the complaint: U.S. Mail,
Restricted Delivery, July 12, 2002.
3. (a) (1) Date of execution of the affidavit required by
section 3301(d) of the Divorce Code: July 8, 2002;
(2) Date of filing and service of the plaintiff's
affidavit upon the respondent: Filed on July 10, 2002, served July
12, 2002.
4. Related claims pending: None
5. Date and manner of service of the notice of intention to
file praecipe to transmit record, a copy of which is attached:
U.S. Mail, August 5, 2002.
Thomas D. Gould
Attorney for Plaintiff
SETTLEMENT AGREEMENT
between
PAUL F. PASSARELLA and SANDRA J. PASSARELLA
John F. King, Esquire
Counsel for
Sandra J. Passarella
Thomas D. Gould, Esquire
Counsel for
Paul F. Passarella
TABLE OF CONTENTS
1. Advice of Counsel
2. Definitions
3. Effective Date of Agreement
4. Effect of Divorce Decree
5. Effect on Divorce
6. Warranty Disclosure
7. Equitable Distribution of Property
8. Custody and Consultation
9. Child Support
10. Warranty as to Existing Obligations
11. Warranty as to Future Obligations
12. Mutual Cooperation
13. Law of Pennsylvania Applicable
14. No Waiver of Default
15. Severability
16. Headings Part of Agreement
17. Counterparts
18. Costs of Enforcement
19. Contract Interpretation
20. Waiver of Liability
AGREEMENT
This Agreement is made this /~ day of-A~, 2002, by
and between SANDRA J. PASSARELLA of Enola, Cumberland County,
Pennsylvania (''Wife'') and PAUL F. PASSARELLA of Williamsburg,
Virginia (''Husband'').
W I TNE S S E TH:
WHEREAS, the parties hereto are husband and wife, having
been married on October 21, 1983, in Mechanicsburg, Cumberland
County, Pennsylvania;
WHEREAS, Husband and Wife are the parents of the following
children, Diana Marie Passarella born on September 26, 1984, and
Jason Daniel Passarella born on September 25, 1986 (the
''Children'');
WHEREAS, certain unhappy differences, disputes,
misunderstandings and difficulties have arisen between the
parties and the parties have decided that their marriage is
irretrievably broken, that it is their intention to live separate
and apart for the rest of their natural lives, that they are
desirous of settling fully and finally their respective financial
and property rights and obligations as between each other
including, without limitation by specification:
1. The settling of all matters between them relating to the
ownership of real and personal property including property
heretofore or subsequently acquired by either party;
2. The settling of all disputes, rights and/or interests
between them arising out of or by reason of their marriage
including but not limited to the past, present and future
support, alimony, counsel fees, costs or maintenance of Wife by
Husband or of Husband by Wife;
3. The settling of all matters between them relating to the
past, present and future support and/or maintenance of the
Children;
4. The implementation of custody and/or visitation
arrangements for the minor children of the parties; and
5. In general, the settling of any and all actual and
possible claims by each party against the other or against their
respective estates.
NOW THEREFORE, in consideration of the premises and of the
mutual promises, covenants and undertakings set forth in this
Agreement and for other good and valuable consideration, the
receipt and adequacy of which is hereby acknowledged by each of
the parties hereto, Wife and Husband, each intending to be
legally bound hereby, covenant and agree as follows:
1. Advice of Counsel. The provisions of this Agreement
and their legal effect have been fully explained to the parties
by their respective counsel, John F. King, Esquire of Friedman &
King, P.C. for Wife and Thomas D. Gould, Esquire for Husband. The
parties acknowledge that each has received independent legal
advice from counsel of his or her own selection, that each has
fully disclosed his or her respective financial situations to the
other including his or her property, estate, assets, liabilities,
income and expenses, that each is familiar with and fully
understands the facts, including the property, estate, assets,
earnings and income of the other, and that each has been fully
informed as to his or her legal rights and obligations. Each of
the parties acknowledges and agrees that, after having received
such advise and with such knowledge, this Agreement is, in the
circumstances, fair, reasonable and equitable, that it is being
entered into freely, voluntarily, and in good faith and that the
execution of this Agreement is not the result of any duress,
undue influence, coercion, collusion and/or improper or illegal
agreement. The parties further acknowledge that they have each
made to the other a full and complete disclosure of their
respective assets, estate, liabilities, and sources of income and
that they waive any specific enumeration thereof for the purposes
of this Agreement.
2. Definitions.
(a) Divorce Code. The phrase ''Divorce Code'' shall be
defined as 23 Pa. Cons. Stat. Ann. § 3101.
(b) Date of Execution of this Agreement. The phrase
''date of execution'' or ''execution date'' of this Agreement
shall be defined as the date of execution by the parties if they
have each executed the Agreement on the same date. Otherwise, the
''date of execution'' or ''execution date'' of this Agreement
shall be defined as the date of execution by the party last
executing this Agreement.
(c) Distribution Date. The phrase ''distribution date''
shall be defined as thirty-one days following the entry of a
final decree in divorce and the filing of Waivers of Appeals by
each party. If the thirty-first day falls on a weekend or
holiday, the distribution date shall be the next business day.
3. Effective Date of Aqreement. This Agreement will
become effective and binding upon both parties upon execution of
this Agreement by both of them.
4. Effect of Divorce Decree--Incorporation, No Merqer.
The parties agree that unless otherwise specifically provided
herein this Agreement shall continue in full force and effect
after such time as a final decision in divorce may be entered
with respect to the parties. Husband and Wife agree that the
terms of this Agreement shall be incorporated but not merged into
any divorce decree which may be entered with respect to the
parties and therefore Wife and Husband agree and each of the
parties does hereby warrant and represent to the other that
should either of them obtain a decree, judgment or order of
separation or divorce in any state, country or jurisdiction, that
party will take all reasonable steps to have this Agreement
incorporated as part of any such decree, judgment or order. The
parties further agree that the Court of Common Pleas which may
enter such divorce decree shall retain continuing jurisdiction
over the parties and the subject matter of the Agreement for the
purpose of enforcement of any of the provisions thereof.
Nevertheless, it specifically is understood and agreed
by and between the parties hereto and each of the said parties
does hereby warrant and represent to the other that should either
of the parties obtain a decree, judgment or order of separation
or divorce in any state, country or jurisdiction, each of the
parties agrees that all of the provisions of this Agreement shall
not be affected in any way by any such separation or divorce, it
being agreed by the parties that this Agreement shall continue in
full force and effect after such time as a final decree a divorce
may be entered and shall survive and not be merged into any such
decree, judgment or order.
5. Effect on Divorce. The execution and delivery of this
Agreement is not predicated upon nor made the subject of any
agreement for the institution, prosecution, defense or for the
non-prosecution or non-defense of any action for divorce. Nothing
in this Agreement, however, shall prevent either Wife or Husband
from prosecuting any other action for divorce, either absolute or
otherwise, on lawful grounds if such grounds presently exist or
may exist in the future or from defending any such action with
such defenses as are presently or may in the future become
available.
Husband previously has filed a divorce action in the
Court of Common Pleas of Cumberland County, Pennsylvania, No. 02-
3273 seeking a divorce decree pursuant to, inter alia, §§ 3301(c)
and 3301(d) of the Divorce Code.
Wife admits the averments contained in the affidavit
filed by Husband on July 10, 2002, pursuant to § 3301(d) of the
Divorce Code. The parties agree to take all legal steps
(including the timely and prompt submission of all documents and
the taking of all actions including executing the appropriate
waivers of notice of the master's hearing, right to file
exceptions, and right to file appeal) necessary to assure that a
divorce pursuant to Section 3301(d) of the Divorce Code is
entered as soon as possible, but in any event no later than three
(3) months from the date of execution of this Agreement.
If, after the execution of this agreement, either party
delays or contests the obtaining of a final, unappealed divorce
decree, that party shall be fully responsible for all attorneys'
fees, costs and/or expenses incurred as a result of such delay in
obtaining the decree.
6. Warranty of Disclosure. Husband and Wife represent and
warrant that they have disclosed to each other the full extent of
their assets, income and liabilities. Each party has had ample
opportunity to review the financial condition of the other and
each party agrees not to challenge the instant Agreement based on
an allegation of lack of sufficient disclosure of assets or
income.
7. Equitable Distribution of Property.
(a) Premises, Vehicles and Personalty. The parties
have previously agreed to and have effected the transfer of all
real and personal property, including motor vehicles, except that
Husband has certain personalty stored at Wife's premises situate
1075 Valley Street, Enola, Pennsylvania. Husband shall remove or
cause to have removed all of his personalty from said premises no
later than thirty (30) days from issuance of Divorce Decree.
Should Husband not remove or cause to have removed such
personalty, Wife may dispose of Husband's personalty, and Husband
hereby generally releases Wife from any and all claims arising
from the removal and disposal of said personalty.
(b) Wife and Husband agree that the foregoing property
dispositions constitute an equitable distribution of all of their
property, pursuant to Section 401 of the Divorce Code, 23 Pa.
Cons. Stat. Ann. § 3401. Wife and Husband hereby waive any right
to division of their property except as provided for in this
Agreement.
(c) After-Acquired Personal Property. Husband and Wife
shall hereafter own and enjoy independently of any claim or right
of the other, all items of personal property, tangible or
intangible, acquired by him or her from the date of execution of
this Agreement, with full power in him or her to dispose of the
same as fully and effectively, in all respects and for all
purposes, as though he or she were unmarried.
RETIREMENT INTERESTS AND BENEFITS
Wife hereby waives any and all right, title and
interest to all existing and future retirement assets or benefits
of Husband.
Husband hereby waives any and all right, title and
interest to all existing and future retirement assets or benefits
of Wife.
8. Custody.
(a) Joint Legal and Physical Custody. It is the
intention of the parties, and the parties agree, to share joint
legal and physical custody of the Children and that with regard
to any emergency decisions which must be made, the parent having
physical custody of the Children at the time of the emergency
shall be permitted to make any immediate decisions necessitated
by the emergency. However, that parent shall inform the other
parent of the emergency and consult with him or her regarding the
emergency as soon as practicable.
(b) Travel. Each parent shall promptly and in a
timely manner notify the other concerning travel plans, travel
arrangements and any delays which may occur.
(c) Access to Records. Each parent shall be entitled
to complete and full information from any doctor, dentist,
teacher or authority and to have copies of any reports given to
either party as a parent. These documents include but are not
limited to medical reports, report cards, birth certificates, and
baptismal certificates.
(d) Living Arrangements. It is agreed that the
Children will reside with Wife, who will have primary physical
custody. Husband shall be given liberal visitation of the
Children upon mutual agreement of Husband and Wife, after giving
previous notice to Wife of his desire to exercise such
visitation.
9. Child Support. Husband shall make payments to Wife on
a monthly basis in the amount of Five Hundred ($500.00) Dollars
for the support of the Children, which payments will terminate in
June, 2005. The support obligation shall be modifiable by way of
a filing with the Domestic Relations office of the county in
which the Wife and Children reside.
10. Warranty as to Existinq Obliqations. During the course
of the marriage, Wife and Husband have incurred certain
liabilities and it is hereby agreed, without the necessity of
ascertaining for what purpose and for whose use each of the bills
was incurred, that of those liabilities that were incurred prior
to the date of execution of this Agreement, Wife and Husband each
covenants, represents, warrants and agrees that, except as may be
otherwise specifically provided for by the terms of this
Agreement, as of the date of execution of this Agreement, no
unpaid liabilities remain which were incurred by him or her or on
his or her behalf for which the other party may be deemed liable;
and, if any such debts or obligations should be determined to
have existed as of the date of execution of this Agreement, or
thereafter, accept as set forth below, the party who incurred
that debt shall indemnify and hold the other party harmless for
and against any loss or liability and costs or expense, including
attorneys' fees, incurred as a result of those liabilities.
In the event that Wife or Husband does not pay when due
any such bills, obligations or debts, the other party shall have
the right but not the obligation to pay such bills, obligations
or debts. If one party pays such bills, obligations or debts
which the other party is obligated to pay pursuant to this
Paragraph, after giving the defaulting party five days' written
notice, the party making the payment shall be entitled to receive
reimbursement from the other party not only for payments made,
but also for any related costs, including counsel fees.
11. Warranty as to Future Obliqations. Wife and Husband
each covenants, represents, warrants, and agrees that, except as
may be otherwise specifically provided for by the terms of this
Agreement, neither of them shall hereafter incur any liability
whatsoever for which the other or the estate of the other may be
liable, and each now and at all times hereafter shall indemnify
and hold harmless the other party from and against any such
liabilities, costs or expenses, including attorneys' fees,
relating thereto incurred by the other party after the date of
execution of this Agreement.
12. Mutual Cooperation. Each party shall, at any time and
from time to time hereafter, take any and all steps to execute,
acknowledge and deliver to the other party any and all further
instruments and/or (within at least fifteen days after demand
therefore) documents that the other party may reasonably require
for the purpose of giving full force and effect to the provisions
of this Agreement.
13. Law of Pennsylvania Applicable. This Agreement shall
be construed in accordance with the laws of the Commonwealth of
Pennsylvania which are in effect as of the date of execution of
this Agreement.
14. No Waiver of Default. This Agreement shall remain in
full force and effect unless and until terminated under and
pursuant to the terms of this Agreement. The failure of either
party to insist upon strict performance of any of the provisions
of this Agreement shall in no way affect the right of such party
hereafter to enforce the same, nor shall the waiver of any breach
of any provision hereof be construed as a waiver of any
subsequent default of the same or similar nature, nor shall it be
construed as a waiver of strict performance of any other
obligations herein.
15. Severability. If any term, condition, clause or
provision of this Agreement shall be determined or declared to be
void or invalid in law or otherwise, then only that term,
condition, clause or provision shall be stricken from this
Agreement and in all other respects this Agreement shall be valid
and continue in full force, effect and operation. Likewise, the
failure of any party to meet her or his obligations under any one
or more of the Paragraphs herein, with the exception of the
satisfaction of the conditions precedent, shall in no way void or
alter the remaining obligations of the parties.
16. Headinqs Part of Aqreement. Any headings preceding the
text of the several Paragraphs and subparagraphs hereof are
inserted solely for convenience of reference and shall not
constitute a part of this Agreement nor shall they affect its
meaning, construction or effect.
17. CounterDarts. This Agreement may be executed in
counterparts, each of which will be an original and which
together shall constitute one and the same instrument.
18. Costs of Enforcement. Any party breaching this
agreement is liable to the other party for all costs and counsel
fees reasonably incurred by the non-breaching party to enforce
his or her rights under the Separation Agreement subsequent to
the date of the signing of this Agreement.
Should either party fail in the due performance of the
terms under this Agreement, the other party shall be able at his
or her discretion to sue for performance or for damages for a
breach of the Agreement. The party who is deemed to have failed
in the due performance of the terms hereunder shall be liable for
all reasonable costs and expenses incurred by the other in suing
for performance or for damages for breach of the Agreement. The
terms contained shall be construed to restrict or limit each
party's right to exercise this election.
19. Contract Interpretation. For purposes of
interpretation and for the purpose of resolving any ambiguity
herein, Husband and Wife agree that this Agreement was prepared
jointly by their respective attorneys.
20. Waiver of Liability. Husband and Wife each knowingly
and understandingly waive any and all possible claims that this
Agreement is, for any reason, illegal or for any reason
whatsoever of public policy, unenforceable in whole or in part.
Husband and Wife each does here by warrant, covenant and agree
that, in any possible event, he or she is and shall forever be
estopped from asserting any illegality or unenforceability as to
all or any part of this Agreement.
IN WITNESS WHEREOF, the parties hereto have set their hands
and seals the day and year first above written.
WITNE~ ........... ~ ~
Thomas D. Gould, Esquire
andra J. t~ssare a
rella
k/p:agr\passarel.agr
IN THE COURT Of COMMON PLEAS
OF'CUMBERLaND COUNTY
STATE Of
PAUL F. PASSARELLA,
Plaintiff
VERSUS
SANDRA J. PASSARELLA,
Defendant
PENNA.
NO. 02-3273 CIVIL
Decree IN
DIVORCE
AND NOW,~i~~
DECREED THAT PAUL F. PASSARELLA
2002, IT IS OrDEReD aND
, PLAINTIFF,
aND SANDRA J. PASSARELLA
,DEFENDANT,
ARE DIVORCED FROM THE BONDS OF MATriMONY.
THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE
BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH a FINAL ORDEr HAS NOT
YEt BEEN ENTERED;
THE SETTLEMENT AGREEMENT DATED OCTOBER 1, 2002 IS HEREBY
INCORPORATED INTO THIS DECREE IN DIVORCE
PROTHONOTARY
PAUL F. PASSARELLA,
PLAINTIFF
SANDBA J- PASSARELLA,
DEFENDANT
IN THE COURT OF COLON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 02-3273 CIVIL TEBM
IN DIVORCE
AFFIDAVIT OF SERVICE
I, Thomas D. Gould, attorney for Plaintiff, in the above
captioned action for divorce, hereby certify that a conformed and
certified copy of the Complaint in Divorce and Plaintiff's
Affidavit under section 3301(d) was served upon the Defendant by
depositing the same in the United States mail, postage pre-paid,
restricted delivery, on July 11, 2002 pursuant to Rule 1920.4 of
the Amendments to the Pennsylvania Rules of Civil Procedure
relating to the Divorce Code.
receipt attached hereto, the
Defendant on July 12, 2002.
As indicated by the signed postal
Complaint was received by the
Thomas D. Gould
ID # 36508
Attorney At Law
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
· Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
· Print your name and address on the reverse
so that we can return the card to you.
· Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
C. S;gnCure
X/(~//~l~.~~r-I Agent
[] Addressee
D. Is delivery add'ss different from item 17 [] Yes
If YES, enter delivery address below: [] No
3. Service Type
[~'Certified Mail [] Express Mail
[] Registered [] Return Receipt for Memhandise
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [~SYes
2. Article Number (~p.v from service label)
70oo bTo o0oo c[7 9
Ps Form 3811, July 1999 D'c.a~stic ~t~turn Receipt
102595-00-M-0952
70 i i + E.?:.C.'.'~