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SENDER: <br /> SECTION . DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. `a <br /> q t <br /> Item 4 if Restricted Delivery is desired. X ; 4 <br /> �,���[' 0 Agent <br /> ■ Print your name and address on the reverse ❑Addressee <br /> so that we can return the card to you. B. eceived by(Printed Name) C. D to of Delivery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. I i..., LIV f\j <br /> 1. Article Addressed to: <br /> D. Is delivery address different from item 1? ❑ es <br /> If YES,enter delivery address below: ❑No <br /> Park State Bank & Trust <br /> Ms. Marcie Zurek <br /> PO Box 9 <br /> 710 West Highway 24 3. S rvice Type <br /> zCertified Mail® ❑Priority Mail Express" <br /> Woodland Park, CO 80866-0009 ❑Registered ❑Return Receipt for Merchandise <br /> -- ❑Insured Mail ❑Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7014 2120 0001 7869 6042 <br /> (Transfer from service label) <br /> PS Form 3811,July 2013 Domestic Return Receipt <br />