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Cep-}► '�e� 1�-1 I- Jae- ,PICAce <br />• Complete items 1, 2, and 3. Also complete A. Signature <br />item 4 if Restricted Delivery is desired. <br />• Print your name and address on the reverse X <br />so that we can return the card to you. <br />• Attach this card to the back of the mailpiece, B. R by <br />or on the front if space permits. <br />1. Article Addressed to: <br />Mr. Gregory Larson <br />14977 Co. Road 97 <br />Haxtun,SQ 80731 <br />f --W <br />❑ Agent <br />Name) C. Date of Delivery <br />% - r.s <br />D. Is delivery address different,from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />a. ziervice lype <br />L9 Certified Mail® ❑ Priority Mail Express- <br />13 Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ Collect on Delivery <br />4. Hestricted Delivery? (Extra Fee) El Yes <br />2. Article Number <br />(rransfer from service label) 7012 3 4 6 0 0000 6 3 8 5 3929 <br />PS Form 3811, July 2013 Domestic Return Receipt <br />U- • <br />ru <br />Er <br />M Postage: $0.48 <br />"n Certified Fee: $3.30 <br />M Return Receipt Fee: $2.70 <br />o Total Postage & Fees: �a �pri< <br />0 <br />O Restricted Delivery Fee <br />(Endorsement Required) J v <br />= Total Postage & Fees $ fit' <br />M -, <br />Sent To <br />u - -- --- ---- ------ Mr. Gregory Larson --------------- <br />Street, Apt. No.; <br />orP °B °X " °. 14977 Co. Road 97 <br />City, State, ZIP +4 ----------'-'--- <br />Haxtun, CO 80731 <br />PS Form 3800, August zuutj bee He??MMr Instructions <br />