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M I W6— Oc�� <br />CCAI-+lf-lea <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 />--Miss Ce(O Zachary <br />--- Dolores a Bank <br />101 S. 6th Street <br />P O BOX 848 <br />Dolores, CO 81323 <br />A. Sigf gjuV , , <br />❑ Agent <br />i <br />❑ Addressee <br />Received by (Printed Name) C. Date of Delivery <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type <br />16 Certified Mall ❑ Express Mall <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mall ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) 13 Yes <br />2. Article Number <br />(Transfer from service iabeq 7 012 3460 0 0 0 0 6384 6 9 9 0 <br />: PS Form 3811, February 2004 Domestic Return Receipt <br />Ir <br />(Domestic Only; <br />- <br />� <br />n <br />Co <br />m <br />Postage: <br />$0,48 <br />`3 <br />Certified Fee: <br />$3 0,k <br />o <br />Return Receipt Fee: <br />$2. Q lrk <br />C3 <br />(E <br />C3 <br />FTotal Postage & Fees: <br />$6.48 <br />C3 <br />.0 <br />-I- <br />(E <br />Total Postage &Fees <br />M <br />Sent To Miss Cecile Zachary <br />ru <br />r-q <br />_________________ Dolores State Bank <br />C3 <br />or Po eoX No. 101 S. 6th Street <br />City, State, ZIP +4 P O Box 848 <br />Dolores, CO 81323 <br />102595 -02 -M -1540 <br />