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-AA - -zc I G - (;�> �- <br />• Complete items 1, 2, and 3. Also complete A. Signature <br />item 4 if Restricted Delivery is desired. X <.) El Agent <br />• Print your name and address on the reverse % /s/ZLL �� ❑ Addressee <br />so that we can return the card to you. B. Received by (Printed Name) C. Date of Delivery <br />• Attach this card to the back of the mailpiece, O <br />or on the front if space permits. 2 % �S <br />D. Is delivery address different,from item 1? ❑ Yes <br />1. Article Addressed to: If YES, enter delivery address below: ❑ No <br />Mr Mynbn D. Sams <br />The First National Bank of Hugo -Limon <br />P O Box 1270 <br />Limon, CO 80828 -1270 3. Service Type <br />Cl- ® 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 <br />(Transfer from service label) 7 014 0150 0000 913 8 6423 <br />PS Form 3811, July 2013 Domestic Return Receipt <br />M . <br />.. <br />ru <br />= P <br />Postage: <br />Co C <br />Certified Fee: <br />rq R <br />Return Receipt Fee <br />Ir <br />o T <br />Total Postage & Fe <br />0 <br />p ( <br />(Endoisemen[ megwrea) <br />O R <br />Restricted Delivery Fee <br />Endor m <br />VP <br />$0.69 - <br />s rq�$3.30 <br />P... 0.70 <br />es <br />J42,? <br />�015 9 <br />O <br />( se on equre) USpS <br />Ln <br />rq Total Postage & Fees $ <br />O <br />a Mr Myron D. Sams <br />rC3 <br />oI The First National Bank of Hugo -Limon <br />P O Box 1270 <br />Limon, CO 80828 -1270 <br />