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M <br />��Ucl CeA.,.�ie ryu' <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 />Thomas O'Rourke <br />O'Rourke Excavating, Inc. <br />2489 C R 15 <br />South Fork, CO 81154 <br />A. Signat <br />X ❑ Agent <br />❑ Addressee <br />B. R eived by (Prrinte/� ame)/ 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 />Wf Certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. (minis rfrom service /a 7012 3460 0000 6384 6891 <br />(Transfer from ben <br />I PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />(Domestic . Coverage <br />Er <br />M Postage $ <br />D <br />C3 Certified Fee <br />Postmark <br />C3 Return Receipt Fee -7 % Here <br />O (Endorsement Required) (J <br />O <br />Restricted Delivery Fee <br />(Endorsement Required) <br />Total Postage & Fees $ <br />M <br />ti Sent To Thomas O'Rourke <br />C3 Street,Apt. O'Rourke Excavating, Inc. <br />M1 or PO Box I <br />C�ty State, . <br />2489 C R 15 -- --- ---- - - - - -- <br />South Fork, CO 81154 <br />