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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3. A. Signature — <br /> ■ Print your name and address on the reverse X [3 Agent <br /> so that we can return the card to you. L-✓ - ❑Addressee <br /> iv� <br /> B. Recey(Print ame) C. Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, r ,b � ' <br /> or on the front if space permits. � �� Y <br /> D. Is delivery address-di rent from item 17 ❑Yes <br /> If YES,on elly ss below: 1� <br /> Marcy Brossman '�, v <br /> Cheyenne County A�261019 �0 <br /> 51 S 1 st Street PO Box 567 2 �� <br /> Cheyenne Wells, CO 80810 10 110t <br /> I I I I III I I I I I I I I I I I I I I I I I I 3. Service Type 1��1 fS��isteredd Mall s� <br /> ❑Adult Signature TM <br /> ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted <br /> 1111 Certified Mail® Delivery <br /> 9590 9402 2543 6306 1186 56 ❑Certified Mail Restricted Delivery ❑Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationTM <br /> "'all ❑Signature Confirmation <br /> 7 017 2400 0000 9205 5949 � ;il Restricted Delivery Restricted Delivery <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br />