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COMPLETE • <br /> ■ Complete items 1,2,and 3. A. SIOn ure 0 Agent <br /> /J <br /> ■ Print your name and address on the reverse !I�x ❑Addressee <br /> L"so that we can return the card to you. Zj t LL <br /> • Attach this card to the back of the mailpiece, I,II B. Received by(Printed Name) C.Date of Delivery <br /> or on the front if space permits. <br /> 1. Article Addressed to: 6 D. Is delivery address different from item 17 13 Yes <br /> ATTN: Mr. Roy Vesta I r, If YES,enter delivery address below: ❑No <br /> Fort Lupton Public Works <br /> 130 South McKinley Avenue <br /> Fort Lupton, CO 80621ice T <br /> 11111111111111111111IT III III III IN 111111111 oi/�d�Signature Restricted Delivery Priority <br /> e$erMail <br /> eC lNapR�es9tri®cte <br /> ❑Adutt Signature 0 Registered Mel <br /> 9590 9403 0406 5163 0691 44 ❑Calti 1fleedd Mail Restricted Delivery 13 ReW Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(transfer fmm servfce fabel3 Collect on Delivery Restricted Delivery Signature Confirmation'"' <br /> Insured Mail 0 Signature Confirmation <br /> 7 015 0 6 4 0 0004 7321 1807 1 insured Mail Restricted Delivery ResMcied Delivery <br /> (over$5DO) <br /> PS Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> POStal Service" <br /> I CERTIFIED MAILM RECEIPT <br /> M1 00177e8fic Mall • <br /> nly <br /> ru CerLtied Mall Fee <br /> m s <br /> tfd eNiC85 FeeS(Ch-kOnxedd ree ns PrapIISY+j <br /> ❑Karam Rocro•pt(h--py) <br /> ❑Retum Receipt(a ncvnnlcl $i P09b.ark <br /> ❑certmad Ma!1 Restricted De!tvr, Here <br /> � ❑Adul!s•5n®tum Requ!rod = <br /> ❑Adult SkpKstura Restrtmed DeRroy a <br /> O Postage —" <br /> `•� Total postage an Fees —"---'""'---� <br /> s <br /> tJl S <br /> � � Fort Lupton Public Works <br /> r`' 130 South McKinley Avenue ___ _ __ <br /> � Fort Lupton,CO 80621 ��� <br />