Laserfiche WebLink
• 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 />Gregory Larson <br />14977 County Road 97 <br />Haxtun, CO 80731 <br />Mat' � <br />A. 'Signature <br />X ❑ Agent <br />❑ Addressee <br />PF-Receive y (Printed Name) C. Date of Delivery <br />Is deli ddress different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type <br />XCertmed Mall ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7012 3460 0000 6385 4315 <br />(Transfer from service labeo <br />PS Form 3811, February 2004 Domestic Return Receipt <br />102595 -02 -M -1540 <br />Postal <br />CERTIFIED 1 • • <br />(Domestic MaH • <br />M <br />Ln <br />CO <br />M <br />4 <br />-B <br />Postage: <br />$0.48 <br />C3 <br />C3 <br />Certified Fee: <br />Reti <br />$3.30 <br />C3 <br />(Endorse Return Rer ee. Fs' <br />$2.70 <br />C3 <br />Restrictf <br />(Endorse <br />C3 <br />Total Post ge & Fees: < <br />$6.48 <br />�`n., <br />Total PU —V. <br />M <br />Sent To <br />(1J <br />-, <br />r-i <br />0 <br />- <br />street,apt. No.; Gregory Larson <br />r' <br />or PO Box No <br />City, State, _P+ 14977 County Road 97 <br />- - - - - -- <br />Haxtun, CO 80731 <br />:00 00% <br />102595 -02 -M -1540 <br />