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COMPLETE •N COMPLETE THIS SECTIONON DELIVERY <br /> ■ Complete items 1,2,and 3. A. Signature <br /> ■ Print your name and address on the reverse t ❑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(Printed Name) C. at of Delivery <br /> or on the front if space permits. E 1np Lin \ a <br /> Is deliveryrs eren� item 1? ❑Yes <br /> Ms.Gail Stencel <br /> If YES,en LLi�I'irr:: ❑ No <br /> High Plains Bank <br /> 502 Central Ave. DEC 2 3 <br /> PO Box 220 <br /> i Wiggins.CO 80654 DIVISION OF REC <br /> II I II�III IIII 'I I(' III f II II I I'IIII I�I II I( 3. Service Type ii Mail Express <br /> ❑Adult Signature ❑Registstered MailTM <br /> ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted <br /> ❑Certified MZ8 Delivery <br /> 9590 9402 5506 9249 0477 55 El 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 0 nfirmationT'" <br /> Insured Mail ❑Signature Confirmation <br /> 7 017 2400 0000 9119 2041 Insured Mail Restricted Delivery Restricted Delivery <br /> over$500) <br /> PS Form 3811,July 201 1PSN 7530-02-000-9053 Domestic Return Receipt <br />