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�Gy <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 mail piece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />Mr. R. Lewi&-F+Rmierl- <br />P O Box 258 <br />Boone, CO 81025 <br />A. <br />X <br />5D APP rOVCA---,L <br />B. rec ivle1d, cby (Priintted� ,Na�mee) C. Date of P� <br />D. Is delivery address different from item 1? U Yes <br />If YES, enter delivery address below: o <br />3. Service Type <br />Certified Mail 0 Express Mail <br />0 Registered 0 Return Receipt for Merchandise <br />0 Insured Mail 0 C.O.D. <br />4. Restricted Delivery? (Extra Fee) 0 Yes <br />2. Article Number 7012 3460 0000 6384 7607 <br />(transfer from service taben <br />102595- 02- M•1540 <br />PS Form 3811, February 2004 Domestic Return Receipt <br />r- <br />0 <br />m <br />M <br />-a <br />C3 <br />C3 new... <br />0 (Endorsement Regwrea) <br />C3 Restricted Delivery Fee <br />(Endorsement Required) <br />— - - 46.48 <br />C3 <br />`n Total Postage & Fees <br />frt <br />LTO Mr. R. Lewis Fillmore r P O B ox 258 ---------------------- <br />Boone, CO 81025 <br />