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)V �C, <br />L e-J Mcu I — FL-Tr-O LC <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 />ebr on the front if space permits. <br />1. Article Addressed to: <br />Douglas J Aiken, Executive Vice P_ <br />Dolores State Bank <br />P O Box 848 <br />Dolor s, CO 81323 <br />Accef -f- /� m end <br />❑ Agent <br />❑ Addressee <br />jB.jiv9ld(Printed Name) C. Date of Delivery <br />t <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />ident <br />3. Service Type <br />❑ Certified Mail® ❑ Priority Mail Express' <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7012 3460 0000 6385 0720 <br />(Transfer from service label) <br />PS Form 3811, July 2013 Domestic Return Receipt <br />Postal <br />RECEIPT CERTIFIED MAILT. <br />a (Domestic mail only, No insuran�e coverage Provided) I <br />ru <br />Cl Postage: �Gti STA7 8 <br />`^ Certified Fee: <br />m Return Receipt Fee: OCT $2 - <br />6 4 <br />2014 ' <br />o Total Postage & Fees: o $61. ,ark <br />C3 - <br />O (Endorsement Required) - <br />O <br />Restricted Delivery Fee <br />r3 (Endorsement Required) <br />-I' Total Postage & Fees $ <br />M <br />.Sant Tn <br />a Douglas J Aiken, Executive Vice President _ <br />Dolores State Bank <br />P O Box 848 <br />Dolores CO 813 23 Offlefflemmo <br />