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COMPLETEY <br /> ■ Complete Items 1,2,and 3. A. Signature <br /> ©Agent <br /> ■ Print your name and address on the reverse so that we can return the card to you. ❑AddresseeX <br /> N Attach this card to the back of the mailplece, B• Received by(Printed Name) 0.Date of Delivery <br /> or on the front if space permits. W t L.4.A--f-P -(!r <br /> 1. Article Addressed to: D. Is delivery address different from item 17 ❑Yes <br /> ATTN: Mr.John Willard and Mrs. Dane I i 14 YES,enter delivery address below: p No <br /> Willard <br /> 2567 County Road 29 <br /> Fort Lupton,CO 80621 _ <br /> ( 3. Service Type --�17 Prtorltty Mall ExpressoEl Adult ' <br /> II tI'Itl iN�Itl(I(I�' I,�I f I, tilt I�'II'Ili nature 0 Registered Mallm <br /> ❑Adult Signature Restricted Delivery 13 Rzatfered Mail estricts <br /> Z CoMfled Matt® Delvery <br /> 9520 94G3 0406 8163 0691 68 0 Certified Meal Restricted Delivery 0 Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(Transfer from service labeo I 0 Collect on Delivery Restricted Delivery 0 Signature Confirmation'* <br /> 17 Insured Mail ❑Signature Confirmation <br /> 7 015 0640 0004 7321 1821 3 Insured Mall Restricted Delivery Restricted Delivery <br /> --_(oyerSL00%���®�. <br /> PS Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> Postal <br /> CERTIFIED MAILO RECEIPT <br /> Domestic Mall • <br /> nly <br /> rZl <br /> r7J Csvttrted Mail Fee <br /> m $ <br /> -xtra iCCe Fees(checkbox.add fueaf aopmyrt W <br /> Ratum Reoatpt(haW-Opy) S <br /> ❑Rotum Receipt(e%ctmnlo) $ _._ PDbtrrterk <br /> ❑Cw%ad Mat ROMrlcted LWwary S _I tiara <br /> � ❑Adult SlpnMue Repuiod S_._,_._-__ <br /> ❑AduR SlgnMura RasMctad�"vay S <br /> O Postago —` <br /> '-� Total Postage and Fees <br /> 0� <br /> s <br /> r.rr s--•T - <br /> r.. 2567 County Road 29 <br /> „ <br />