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• Complq! L6 ; 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 />Laurine Koellner <br />L & L Ready Mix <br />P.O. Box 218 <br />Haxtun, CO 80731 <br />o59 <br />A. Signature <br />Postal <br />❑Agent <br />CERTIFIED MAIL,, RECEIPT <br />addressee <br />B. Received by (Printed Name) <br />c At,t�, f l� i «� �t,� 1 <br />C Date of Delivery <br />XA -30 y <br />D. Is delivery address different,from item <br />1? ❑ Yes <br />If YES, enter delivery address 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 2 616 <br />(Transfer from service label) <br />PS Form 3811, July 2013 Domestic Return Receipt <br />Postal <br />CERTIFIED MAIL,, RECEIPT <br />.11 <br />Do <br />• <br />ni <br />co <br />,..t1<T <br />�' <br />C/ <br />a <br />Certified Fee: <br />$0.69 <br />$0.69 <br />a- <br />Return Receipt Fee: i �. <br />$3 .3 0 <br />$3.30 <br />C3 <br />�G <br />U� <br />a <br />Retu <br />(EndorserTotal Postage 8r Fees `�n,._,,.-' <br />$6,69 <br />C3 <br />Restricted Derwair � .• <br />(Endorsement Required) <br />r-1 <br />Total Postage &Fees <br />I] <br />Sent To Laurine Koellner <br />rq <br />L & L Ready Mix ------ -- --- <br />------- ------ - ----- <br />p <br />°.. <br />Street, Apt. No.; P.O. Box 21 <br />or Po Box No. Haxtun, CO 80731 ----- .— <br />-------------------- <br />City, State, ZIP +4 <br />PS Form :r0 August 2006 See Reverse <br />for Instructior"I <br />