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• <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. Tom Bennett <br />First Pioneer National Bank <br />150 &4nterocean Street <br />Holyoke, CO 80734 <br />114 /1 770 7 5— <br />A. Signature <br />S� ❑ Agent <br />aAD ❑ Addressee <br />B. Received by Fnted Name) I C. Date of Delive <br />D. Is delivery address different from, itt rn 1? 11 Yes <br />If YES, enter delivery addre s`�fow: ❑ No <br />3. Service Type <br />JO 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) 7012 3460 0000 6385 0133 <br />PS Form 3811, July 2013 Domestic Return Receipt <br />