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| Title | |
| FormNumber | 7 |
| Revision | |
| Division | Dead Letter Office |
| WhereUsed | Form with receipt at the bottom to accompany a dead letter returned from the DLO to the postmaster or origin. |
| EKU | 1865 unk |
| LKU | 1867 unk |
| Notes | |
| Source | SS |
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