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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 />A. Signature <br />0 Agent <br />X'"DEPY. OF STATE 0 Addressee <br />B. Received by (Printed Name) C. Date of Delivery <br />DEC, 0 6 2011 <br />D. Is delivery address different f J? 0 Yes <br />If YES, enter delivery addre* 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) 0 Yes <br />2. Article Number <br />(transfer from service label) 7007 1490 0003 5613 7960 <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 <br />C:3 <br />J <br />Departmul 1L <br />`iiioridalect*'Ons <br />vvislon Of E <br />:)OM 31 R.A. Gray <br />B'J' et <br />C3 Street`,cl� <br />J:3 poa,,x Na. <br />259 <br />South Bronough Street <br />ralliahassee, FL '32399-0 <br />