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I <br /> COMPLETE • <br /> ■ Complete items 1,2,and 3. A. Signature <br /> ■ Print your name and address on the reverse X , ❑Agent <br /> so that we can return the card to you. Addressee <br /> ■ Attach this card to the back of the mailpiece, B. Received by((PPfint�edLNaame) 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 ❑ <br /> If YES,enter delivery address below: ❑No <br /> Mat _k Jacqueline Ackerman <br /> 7724 E. County Road 16 <br /> Johnstown, CO 80534 <br /> 3. Service Type ❑Priority Mail Express® <br /> II I III II I'I I�)I I I) IIII IIII I II II'I'I I I ❑Adult Signature ❑Registered Mall R <br /> ❑Adult Signature Restricted Delivery ❑Registered Mall Restricted <br /> cemfled Mal la ��erY <br /> 9590 9402 1644 6053 5431 60 ❑Certified Mall Restricted Delivery �1Retum Receipt for <br /> ❑Collect on Delivery Mere tandise <br /> 2. Article Number(transfer from service label ❑Collect on Delivery Restricted Delivery ure ConfirmatlonTm <br /> ❑Insured Mail ❑Signature Confirmation <br /> Alred Mall Restricted Delivery Restricted Delivery <br /> 7013 1090 0002 0962 7728 �er$500) <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> USPS TRACKING# <br /> First-Class Mail <br /> Postage&Fees Paid <br /> USPS <br /> Permit No.G-10 <br /> 9590 9402 1644 6053 5431 60 <br /> United States •Sender:Please print your name,address,and ZIP+4®in this box* <br /> Postal Service 22 <br /> DEC IE W t� y Brossman <br /> enne County Administrator <br /> JI1I 2 9 019 Box 567 <br /> enne Wells, CO 80810 <br />