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• 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 />MU" Fw I eleuse <br />A. Signature <br />/, ❑ Agent <br />`—� i1'1i� ❑ Addressee <br />Received by (Printed NamV C. Date of Delivery <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />Keith Moffett <br />Peoples National Bank <br />400 Harrison Avenue <br />3. Service Type <br />Leadvil le, CO 80461 <br />0 Certified Mails <br />❑ Priority Mail Express'' <br />❑ Registered <br />❑ Return Receipt for Merchandise <br />❑ Insured Mail <br />❑ Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number <br />(Transfer from service label) 7012 <br />3460 0000 6385 <br />4575 <br />PS Form 3811, July 2013 Domestic Return Receipt <br />'octal Service,. <br />ITIRM MAII _.. RIcCFic <br />Ln ' <br />Ln <br />$0.48 <br />Cc postage: $3.30 <br />M Certified Fee: X2.70 <br />Return Receipt Fee: NTl a'V <br />° }� $ F �k <br />C3 (En Total postage & Fees: <br />I3 Re <br />O (Endorsement Required) <br />�.. Total Postage &Fees 711�. , t -• <br />f7I Rr 3j�o, <br />Sent To _ - <br />ru Keith Moffett <br />,a Ap <br />- -- - t. o.- N---- <br />° ° <br />Street, ; --------------- <br />C3 or PO Box No. Peoples National Bank <br />City State,ZlP+ 400 Harrison Avenue ------------------ <br />Leadville, CO 80461 ., <br />