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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 />Article Addressed to: <br />Gregory Larson <br />1497Co. Rd. 97 <br />Haxtun, fp 8 0731 <br />2• Article Number <br />(Transfer from service label) <br />PS Form 3811, February 2004 <br />cD►z <br />A. Signature <br />X <br />0 Agent <br />B. Receive b y (Printed Name <br />0 Addressee <br />C. Date of Delivery <br />D. Is delivery address different from item 1 ? Yes <br />If YES, enter delivery <br />ry address below: <br />❑ No <br />3. Service Type <br />Cl Certified Mail ❑ Express Mail <br />❑ Registered ❑ Retum Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />I. Restricted Delivery? (Fktra Fee) <br />7014 0150 ;1]000 Yes <br />Domestic Return Recelpt <br />M. <br />9138 317.0 <br />102595 -02 -M -1540 <br />C3 <br />! • .•. <br />M <br />i N nom% <br />Cc L <br />1,. $0.69 <br />ar postage ;$3.30 <br />Certified tified Fee: ► GILI $2.70 <br />Fie, eceipt Feej.' <br />E3 (Endorse Return R $6.69 <br />Restrict $� Fees: 802 <br />3 (Endorse Total postage ,�� <br />,n <br />0 Total Postage & Fees <br />Sent To Gregory Larson <br />r� 14977 Co. Rd. 97 <br />--- - --- -- -- - - -- <br />[3 Street, Apt. No.; ------------------ ----- °° <br />r` or PO Box No. Haxtun, CO 80731 <br />City, State, ZIP+4 <br />-------- -------- --- ---- ---' <br />_ eb rorm 3800, August 2006 See Reverse for Instructions' <br />