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SENDER: COMPLETE THIS SECTION 1! COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3. A ature <br /> ■ Print our name and address on the reverse ❑Agent <br /> so that we can return the card to you. X ❑Addressee <br /> ■ Attach this card to the back of the mailpiece, B• Received by(Psi ted Name) Da ,te Delivery <br /> or on the front if space permits. �[7?�� <br /> 1. Article Addressed to: D. Is delivery address different from item 1? ❑Y <br /> If YES,enter delivery address below: o <br /> Tom Tomky <br /> TBK Bank <br /> 310 East 3rd Street <br /> La Junta,CO 81050 <br /> 3.it I Ililll ilii Ili i II it i I II I it I II I lil III III I I III ❑Adult Signaturece Type <br /> Restricted Delivery ❑❑Re4i�d Mail <br /> Restricted <br /> ❑Adult Signature ❑Registered Mall <br /> 9590 9402 3488 7275 7598 96 0 Certified Mail® <br /> ❑Certified Mail Restricted Delivery ❑Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> ❑Collect on Delivery Restricted Delivery ❑Signature ConflrmatlonTM <br /> 2. Article Number(Transfer from service/abe4 ❑Insured Mail ❑signature Confirmation <br /> 7 016 2 710 0000 2965 4158 ❑Insured Mail Restricted Delivery Restricted Delivery <br /> (over$500) <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> Postal <br /> .o CERTIFIED o RECEIPT <br /> Ln Domestic <br /> r� <br /> Ln <br /> _ - <br /> a Certified Mail Fee E <br /> nj $ <br /> Extra ces& ees(checkbox,add <br /> O m Receipt(hardcopy) <br /> C] ❑Retum Receipt(electrmi,) $ ' <br /> E3 ❑Certified Mail Restricted Delivery $ •_� ' <br /> []Adult Signature Required $ Here <br /> IM ❑Adult Sgnatum Restricted Dell ery$ <br /> Postage t ' <br /> fti $ ` <br /> fly Total Postag F <br /> $ <br /> Sent To T <br /> O Tom TOITlk�-=. <br /> f� 9troef and Apt.No.,or P'O Box No ---- <br /> TBK Bank -- <br /> cny ware;zi�+d ------------------------- 310 East 3rd Street <br /> La Junta,CO 81050 <br />