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�VJL <br />VV <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 />Dave Hornung <br />Kit Carson County <br />P.O. Box 160 <br />Burlington, CO 80807 <br />U <br />A. Signatyre <br />❑Agent <br />X 0 Addressee <br />B. Received by (Printed Name) C. Date of Delivery <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: 0 No <br />3. Se ice Type <br />Certified Mail® ❑Priority Mail Express`" <br />0 Registered 0 Return Receipt for Merchandise <br />❑ Insured Mail ❑ Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) 0 Yes <br />2. Article Number 7 014 0150 0000 91, 3 8 7949 <br />(Transfer from service label) <br />PS Form 3811, July 2013 Domestic Return Receipt <br />Er (Domestic Mail Only; No Insurance Coverage Provided) <br />rr <br />)$2. <br />Postage: h Certified Fee: ° o ReturrReturn Receipt Fee: � (EndorsemE '�, RestdctedTotal Postage & Fees: o� <br />l- (Endorsemc AU <br />....- <br />,- <br />ri Total Postage & Fees <br />C3 <br />n- Sent To Dave Hornung - <br />a <br />---"-----"""""""----- Kit Carson Count <br />O Street, Apt. No.; v "'"'--"'"""-"""'-'--- <br />r- or PO Box No. P.O. Box 160 <br />-------------- - - - - -- - --------------- - - - - -- <br />City, State, ZIP +4 <br />Burlington, CO 80807 <br />PS Form 3800, August 2006 See Reverse for InstructioN <br />