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U�- ZOoo -I4 � <br />L lo c Lq�,i za v <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 />Mr. Dana Siekman <br />Colorado East Bank & Trust <br />P O Box 286 <br />Stratton, CO 80830 <br />A. Si ture <br />i J�c G <br />Addressee <br />ssee � <br />B. Received b Hinted Name) Date of Delivery <br />D. Is delivery address different from item 17 ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type i <br />WCertified WHO 0 Priority Mail Express'" <br />❑ Registered ❑ Return Receipt for Merchandise I <br />❑ Insured Mail ❑ Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7014 0150 0000 9138 9998 <br />(Transfer from service label) <br />PS Form 3811, July 2013 Domestic Return Receipt <br />Co u Ke <br />D- <br />� <br />l` Postage: �.c $0.69 <br />rn Certified Fee: C STA'a $3.30 <br />Return Recei p t Fee: ;' $2.70 <br />C ,i <br />ED Total Posta e & Fee (MAR 18 6.69 <br />M Return g <br />E3 (Endorsemen...w—_, <br />Restricted Delivery Fee <br />t3 (Endorsement Required) 0 USp� <br />Ln <br />r q Total Postage & Fees <br />E3 <br />sentn Mr. Dana Siekman .............. <br />or PO , Colorado East Bank & Trust <br />sir "eei <br />city "s P O Box 286 <br />Stratton, CO 80830 <br />