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•MijL,:TE THIS SECTION COMPLETE • ON DELIVERY <br /> ■ Complete itarA2,and 3. A. Signature <br /> ■ Print your name and address on the reverse R 0 Agent <br /> so that we can return the card to you. da ,i 1 11 Addressee <br /> ■ Attach this card to the back of the mailpiece, B• Received by Pnnte ame) C. Da�t1e of Delivery <br /> or on the front if space permits. �+r1 .. �1<2 2 �, oc(6, -.),1 <br /> 1. " `—•' - D. Is delivery address different from item 1? ❑Yes <br /> M5.Linda Baltazar <br /> If YES,enter delivery address below: 0140 <br /> i <br /> High Plains Bank <br /> 502 Central Ave. <br /> PO Box 220 <br /> Wiggins,CO 80654 <br /> M-1981-286 Eric Scott <br /> II I IIIIII III II I III I I I III II I I III)I I II I III 3. Service Type El Priority Mail Express <br /> 13 <br /> ❑Adult Signature ❑Registered Mail" <br /> ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted <br /> ❑Certified Mails Delivery <br /> 9590 9402 5506 9249 0490 18 ❑Certified Mail Restricted Delivery ElReturn Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery El Signature Confirmation— <br /> sured Mail ❑Signature Confirmation <br /> 7 017 2400 0000 9119 17 4 7 sured Mail Restricted Delivery Restricted Delivery <br /> _ver$500) <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br />