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COMPLETE •N COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3. A. Signature <br /> ■ Print your name and address on the reverse X CI Agent <br /> so that we can return the card to you. ' — ❑Addressee <br /> ■ Attach this card to the back of the mailpiece, B. Rkelved by(P hted me) C. Date of Delivery <br /> or on the front if space permits. <br /> 1. Article Addressed to: D. Is deliv �1? ❑Yes <br /> If YES,enter delive ❑No <br /> Jean Johnson 7 7�OJ <br /> GreatAmencan Insurance Company I <br /> 420 E. South Temple, Suite 300 Q770,V <br /> Salt Lake City, UT 84111 <br /> 111 IIII Jill <br /> II I I (' (( i it II I I I II I I III 3. Service Type ❑Priority Mail Express® <br /> ❑Adult Signature ❑Registered MailTr <br /> ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted <br /> 9590 9402 3488 7 ] elD 0 Certified Mail® ivry e <br /> ❑Certified Mail Restricted Delivery ❑ .I v Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(Transfer from service label) El Collect on Delivery Restricted Delivery ❑Signature ConfirmationTm <br /> ❑Insured Mail ❑Signature Confirmation <br /> 7 16 ,G 71 0000 2965 1324 ❑Insured Mail Restricted Delivery Restricted Delivery <br /> (over$500) <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br />