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2-O-C M- )9c62- -131 <br />Ce-r+l*-Fj't8 MalI - Cf(F- <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 />X <br />B. <br />C. <br />lz 4gent <br />❑ Addressee <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />Employers Mutual Casualty Company <br />Elke Eriksen <br />P0 Box 3199 <br />Greenwood Village, CO 80155 -3199 3erviceType , ,,! <br />[a Certified Maq ❑ Expr€,s.Man ' <br />❑ Reglstered I.Eiet km Receipt for Merchandise <br />❑ Insured Mail ,C"]' bAD. <br />14. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. (Vane rfrom 7012 3460 0000 6384 5887 <br />(Transfer from service labeQ <br />PS Form 3811, February 2004 Domestic Return Receipt <br />102595 -02 -M -1540 <br />Postal <br />,0 <br />RECEIPT CERTIFIED MAILT. <br />(Domestic Mail Only; No Insurance <br />Coverage r,,wyjucruj <br />CO <br />Ln <br />_ <br />.7' <br />M <br />Postage: <br />- -�, <br />,0 <br />M <br />,.• <br />Certified Fee: <br />Return Receipt <br />$0.48 <br />0 <br />Fee: <br />$3.30 <br />C <br />( Re -_ tal Postage & <br />Re „�...-- Fees: <br />$2 70 <br />C3 <br />(EndorsementRequireo) <br />.-$6.48 <br />M <br />m <br />Total Postage & Fees $ - <br />a <br />Sent <br />Employers Mutual Casualty Company <br />° <br />or PC Elke Eriksen <br />%ry P 0 Box 3199 <br />Greenwood Village, <br />CO 80155 -3199 <br />102595 -02 -M -1540 <br />