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• Complete items 1, 2, and 3. Also complete A. <br />item 4 if Restricted Delivery is desired. X <br />• Print your name and address on the reverse <br />so that we can return the card to you. B <br />• Attach this card to the back of the mailpiece, <br />or on the front if space permits. < <br />1. Article Addressed to: <br />Dean Omriston <br />Baca County <br />741 Main St-,Suite 1 <br />Springfield, CO 81073 <br />C. F)at6 of <br />D. Is delivery aic ress dill re t from item 1? El Yes <br />If YES, enter delivery a dress below: ❑ No <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 7 014 0150 0000 913 8 4146 <br />(Transfer from service labe <br />PS Form 3811, July 2013 Domestic Return Receipt <br />ro <br />I Postage: p zl <br />PV.V' <br />M <br />Certified Fee: <br />$3.30 <br />Return Receipt Fee: <br />$2.70 <br />° <br />° <br />Total Postage & Fees: <br />g <br />$6.69 <br />° <br />(End, <br />Restricted Delivery Fee <br />(Endorsement Required) <br />O <br />ul <br />r-i <br />Total Postage & Fees <br />$ J <br />O <br />.. <br />Sent To Dean Orrrvston <br />7 <br />Baca County <br />° <br />3`treet, Apt. _&6... 741 Main St-Suite 1 ......----'°" <br />o.; CO 81073 <br />Springfield, <br />r`- <br />or PO Box No. <br />City Siete, ZIP +4 <br />= PS Form 3800, August 20Uti ^ °° ^ ° ° °' °° "" "' °" ° °""'- I <br />