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Certified Mail Receipts <br /> SENDER: COMPLETE THIS SECTION COMPLETE THIS DELIVERY <br /> ■ Complete items 1,2,and 3. A. S'gnature <br /> 01 Adept <br /> X■ Print your name and address on the reverse ressee <br /> so that we can return the card to you. C. Date of Delive <br /> ■ Attach this card to the back of the mailpiece, B. Receiv by(Printed ar>fe) J)J Delivery <br /> or on the front if space permits. <br /> 1 Article Addressed to: D. is delivery address different from item 1? ❑Yes <br /> If YES,enter delivery addrdss below. ❑No <br /> Jacque Goemmer <br /> L Otto Goemmer <br /> P.O.Box 165 <br /> La Vera,CO 81055 <br /> 3 Service Type C Priority Mal ExpressQD <br /> L Aoun Siynatuio Registered l tail"" <br /> ❑Adult Signature Restricted Delivery Ci Registered Mail Restncted <br /> ❑Certified Mad® Delivery <br /> ❑Certified Mad Restricted Delivery ❑Return <br /> etur Receipt for <br /> ❑Collect on Delivery Merchandis❑Signature ConfinnatlonTM <br /> o e.r pie nl,, K.,/T,—far from envirn 1n1-11 El Collect on Delivery Restricted Delivery Signature Confirmation <br /> 7 014 2120 0001 7885 3445 l Restated Delivery Restricted Delivery <br /> PS Form 3811 July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> Postal <br /> CERTIFIED • <br /> Ln <br /> Domestic Mail Only <br /> mFor delivery information,visit our website at www.usps.com% <br /> N -_ <br /> co Postage: $Q 460 <br /> Co Certified Fee: <br /> r` $i,350 <br /> r-1 Return Receipt Fee: t -'$?,750 <br /> Rat <br /> C3 (Endorse Postage and Fees , <br /> Resmcte, _..._., $6.56 <br /> a (Endorsement Required) <br /> nJ <br /> rU Total Postage 8 Fees <br /> o Jacque Goemmer <br /> rl L Otto Goemmer ,_ <br /> p 3treef&ifpf.Flo, P.O.Box 165 <br /> r- or PO Box No. La Veta,CO 81055 <br /> Clry State,ZIP+4 <br /> PS Form <br /> :rr Ju1V 2014 <br />