Case 1:23-cv-00122-RGA Document 13-3 Filed 02/07/23 Page 1 of 2 PagelD # 675
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`__Case1:23-cv-00122-RGA Document 13-3 Filed 02/07/23 Page 2 of 2 PagelD #: 676
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`™ See the Privacy Notice on the reverse of Copy4.
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`ISENDER’S INFORMATION
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`11. Importer’s Reference(if applicable and known)
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`PS Form 2976-R,April 2016
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`4- Sender’sCopy
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