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�)- � � 00 6 103 <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 />Vernon Dilley <br />Dilleys Sand & Gravel <br />1914 Edmunds St. <br />P.O. Box 125 <br />Brush, CO 80723 <br />A. Signature <br />v <br />❑ Agent <br />❑ Addre <br />b- Heceived by (Printed m� <br />-) C. Date of Deli <br />D. Is delivery address diffe nt from item 1? Cl Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type <br />❑ Certified Mailz ❑ Priority Mail Express- <br />0 Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) <br />2. Article Number ❑ Yes <br />(Transfer from service label) 7 014 0150 0 0 0 0 9138 2425 <br />S Form 5011, July 2013 <br />Domestic Return Receipt <br />Lrl (Domestic Only; Provided) <br />r11 <br />ru %sta —' <br />ru ge: .�.� <br />Certified F . <br />C' $0.69 <br />M Return Re eeipt Fee: _ $3.30 <br />Ir <br />JhQ ' $2.70 <br />Total P <br />osta % <br />ED raecu::.:,�...,.r, ge 8, Fees. ,�',�� <br />$6p (Endorsem .69 <br />C3 Restricted Delivery Fee <br />0 (Endorsement Requiredl <br />U-) <br />a Total Postage f. Vernon Dilley <br />sentro Dilleys Sand & Gravel <br />1914 Edmunds St. <br />'� Sheer, npr.'No:F <br />3 or PO Box No. P.O. Box 125 <br />city siaie, zi ;+ Brush, CO 80723 "......"""" °' <br />'PS Form :0r August 2006 See Reverse for Instructions <br />