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• Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />• Print your name and address on the reverse <br />so that we can return the card to you. <br />• Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />Vionaa Department of State <br />Division of Elections <br />Room 316, R.A. Gray Building <br />500 South Bronough Street <br />Tallahassee, FL 32399-0250 <br />2. Article Number <br />(transfer from service label) <br />PS Form 3811, February 2004 <br />C:3 <br />J <br />ti <br />A. Signature <br />X;')fzP'I-. OF STATE <br />0 Agent <br />0 Addressee <br />B. Received by (Printed Name) <br />f C. Date of Delivery <br />DEC 0 6 2011 <br />D. Is delivery address different from qem J?. <br />0 Yes <br />If YES, enter delivery addreS#W: <br />11 No <br />3. Service Type <br />04 Certified Mail 0 Express Mail <br />0 Registered XReturn Receipt for Merchandise <br />11 Insured Mail 11 C.O.D. <br />4. Restricted Delivery? (Extra Fee) 13 Yes <br />Domestic Return Receipt <br />117 Postage & Vees of state <br />:3- 'ijorjda Department <br />r-1 s'ent TO V.jv,sjon of Elect -'Ons .tjding <br />r - ----- - 316, R.A. Gray <br />C3 Street, Na. room3ronough Street <br />C3 or PO Box g-()250 <br />r` Cify, State; zip Soo South <br />FL 3239 <br />-Talliat)ass , <br />102595-02-M-1540 <br />