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Certified Mail Receipts <br /> COMPLETEi SENDER: • <br /> ON DELIVERY <br /> • Complete items 1,2,and 3. A. Signature 2 / <br /> ■ Print your name and address on the reverse Z G ❑Agent <br /> 4',0W .ve(Ami return the Card to you. ❑Addressee <br /> ■ Attach this card to the back of the mailpiece, eceived by(Printed Name) C. Date of Delivery <br /> _ or on the front if space permits. <br /> 1 Article Addressed to: D. Is delivery address different from item 1? ❑Yes <br /> It YES enter delivery address teluw ❑ No <br /> Jack Clark, Jr. <br /> P.O. Box 767 <br /> ,.S1verton, CO 81433 <br /> 3 T;fib Priority Mal E,.Nresse <br /> Adult bignaturt G Hegistered Mad"" <br /> ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted <br /> "Certified Mail® Delivery <br /> D Certified Mad Restricted Delivery ❑Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> _._ ., _.__- ,____�__r__�___-_; — n r:ll—f nn nelivery Restricted Delivery O Signature Confirmation'"^ <br /> 701 4 212 0 0 0 1 7 8 8 5 3 4 8 3 ❑Signature Confirmation <br /> Restricted Delivery Restricted Delivery <br /> — --— --towr3door <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> Postal <br /> CERTIFIED ® • • <br /> M DomesticCo <br /> mour website at www.usps.com!'. <br /> r r � r � <br /> CoLn <br /> Co Postage <br /> r- Certified Fee: $0.460 <br /> C3 R <br /> Return Receipt Fee: $3.350 <br /> (Endor <br /> $2.750 <br /> C3 <br /> Res'Total Postage and Fees:/%' y <br /> C3 (Endoi g <br /> ni $6.56 <br /> r-9 Total Postage&Fees <br /> nj <br /> r,. <br /> -r Sent To Jack Clark, JeN m ` <br /> C3 Streef$V.No P.O. Box 767 r- <br /> or PO Box No. <br /> Silvertoncity scare,YIX _ r <br />