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• Complete items 1, 2, and 3. Also complete <br />A. Ign re <br />$0.48 <br />item 4 if Restricted Delivery is desired. <br />X--� <br />❑ Agent <br />• Print your name and address on the reverse <br />Return Receipt Fee: <br />❑ Addressee <br />so that we can return the card to you. <br />• Attach this card to the back of the mailpiece, <br />B. eceive b Prin d <br />i 41C�) <br />a of /livery <br />or on the front if space permits. <br />�1� <br />t <br />1. Article Addressed to: <br />D. Is delivery address different i m 1? ❑Yes <br />If YES, enter delivery address elow: <br />❑ No <br />Jason Burkey <br />Oldcastle SW Group, Inc dba United Companiejlesa County <br />Total Postage &Fees <br />2273 River Road <br />Grand Junction, CO 81502 <br />C3 <br />3. Service Type <br />171-- <br />tVCertitled Mail ❑ Express Mail <br />Grand Junction, CO 81502 <br />I.S —L- <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) <br />❑ Yes <br />2. Article Number <br />(Transfer from service labeo 7012 <br />3460 0000 6384 6983 <br />, <br />I PS Form 3811, February 2004 Domestic Return Receipt <br />102595•02•M -1540 <br />(Domestic Mail C <br />' For delivery inform, <br />co <br />Postage: <br />$0.48 <br />M <br />.Jo <br />Certified Fee: <br />$3.30 <br />C3 <br />Return Receipt Fee: <br />4.70\ <br />E3 <br />Irk <br />°o <br />('Total Postage & Fees: <br />O <br />(Endorsement Required) <br />-I• <br />M <br />Total Postage &Fees <br />ru <br />C3 <br />Jason Burkey <br />171-- <br />Oldcastle SW Group, Inc dba United Companies of Mesa County <br />2273 River Road <br />Grand Junction, CO 81502 <br />I.S —L- <br />A-elerse Tor Instructioni, <br />