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21>11 <br />�k Cer� -� �iecl Mai l - 14-mL, i- <br />■ 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 />Mr Jason Burkey <br />Oldcastle SW Group, Inc dba <br />United Companies of Mesa County <br />2273 River Road <br />P O Box 3609 <br />Grand Junction, CO 81502 <br />A. Signature <br />X <br />❑ Agent <br />❑ Addressee <br />B. Received by (Printed ame) <br />C. Date <br />ci Deli ery <br />D. Is delivery address different f m4tsa?? <br />Yes <br />If YES, enter delivery aodFq�t 'j <br />❑ No <br />A <br />3. Service Type <br />Certified Mail ❑ re <br />E3 Registered 13 Retum pt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number <br />(Transfer from service label) 7`012 3 4 6 0 0000 6 3 8 4 5 7 71 <br />PS Form 3811, February 2004 Domestic Return Receipt <br />o. • <br />f`- <br />N n <br />Co <br />M Postage $ <br />.A <br />Certified Fee - <br />E3 Postmark <br />O Return Receipt Fee Here <br />C3 (Endorsement Required) -2 '" <br />C3 <br />Restricted Delivery Fee <br />O (Endorsement Required) <br />-r Total Postage &Fees y <br />M <br />9antro Mr Jason Burkey <br />ru Oldcastle SW Group, Inc dba <br />---- - - - - -- ------------------ <br />� Street,Aj United Companies of Mesa County <br />or PO Be <br />- - - - -- 2273 River Road <br />cry Stat P O Box 3609 <br />Grand Junction, CO 81502 - <br />102595 -02 -M -1540 <br />