Laserfiche WebLink
A.Signature: (0 Addressee orO Agent) <br /> Erwp Ntntrs 1,2,and 3X <br /> Attach tttirCfyed t0 thetoftlr•tOf�iece,or on o <br /> the pork If space Is Z <br /> s4 K -1 B.Received By:(Printed Name) C.Date of Del" S ❑❑ <br /> s • ` V E <br /> Article Addressed to: D.b delivery address diflererd from Rem 1? ❑Yes <br /> (Grand Headwaters LLC RYES,enbrdelNaryedMesstblow ❑No • <br /> 01 <br /> 929 "le rl St Ste 300 a <br /> otddoi CO 80302-5355 <br /> � � Y <br /> U <br /> V ` <br /> 7 A <br /> ( Y m ro + 3 <br /> C\\ a (� <br /> Nilll � �� ( III I111 • �\' � $W <br /> lli�ll�llllillllilililllil illllll 1.1 1�,�, 3.ServieeType�ettiLec•.a,i Q m <br /> 190 9118 9956 2801 0188 57 <br /> Article N, r(Transfer from se Z.label) tt = <br /> ro <br /> c 00 <br /> a Form 3811 Facsimile,July 2015(SDC 3930) Domestic Return Recsf `o r- <br /> m <br /> COMPLETE ca <br /> SENDER: COMPLETE THIS SECTION <br /> p to <br /> A.Signature: (❑Addressee or❑Agent) E r- 11 <br /> ■Ensure items 1,2,and 3 are completed. E « N so®! <br /> r <br /> ■Attach this card to the back of the matiplece,or on $ `o Cv7 00 o, <br /> the front if space permits. m <br /> B.Received By:(Printed Name) C.Date of Del iv m m <br /> a8 a <br /> e € X <br /> c � O <br /> • <br /> 1.Article D.Is delivery address different from Item 1? ❑Yes N <br /> If YES,enter delivery address below: ❑No • w•� <br /> 7864 Highway 65 CL r; <br /> Delta CO 81416-8341 =g <br /> W Q« <br /> i <br /> II I fill I�I'IIII�i illll III II I II I II'i III I'll I III 3.Service Certified Mau : ' , \ O •o <br /> o <br /> 9490 9118 9956 T801 0188 15 . c <br /> °m <br /> • c v E.. <br /> 9414 7118 9956 2801 0182 79 ❑ z <br /> • <br /> `o <br /> 2.Article Number(Transfer from service label) <br /> 8 - <br /> PS Form 3811 Facsimile,July 2015(SDC 3930) Domestic Return R ❑ a 'w <br /> a ea <br /> �ENDER: • • • • • DELI <br /> m m$ ��► <br /> • M.'�SpilaW Addressee or❑ peril) <br /> Ensure items 1,2,and 3 are completed. o o <br /> Attach this card to the back of the mailpiece,or on ✓ • rn �/ c• <br /> the front if space permits. < x m <br /> B.Receive y:( nt Name) .Date of Del cry <br /> era:�l <br /> .Article Addressed to: D. delivery address diMererK from Item 1? C <br /> If YES,enter delivery address below: Lilo <br /> Ric -lard Frazier Rev��a l: o <br /> 2068 7 Pearl CA REM <br /> Delta CO 8141 e-670CD <br /> 8 <br /> to N N <br /> CO <br /> 21- <br /> =E E ill O ee <br /> a i m <br /> II I IIII Illllllli I iilil III it I I I Illii II ii!!i I ICI 3.Service Type <br /> `crtfl•o aa+ 9 m m <br /> 9490 9118 9956 2806 9093 78 • E$ 04 O <br /> '.Article NWAM 776f8�iA5foilB8St9�B10fi�j c m <br />