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<br />o <br />P 436 79l]'~0~' o <br />~ O <br />US Postal Service ~ <br />Receipt for Certifie <br />No Insurance Coverage Provided,_ ~~ <br />iem tp- <br />Roben V. Mayne <br />Mr <br />. <br />~raet~ Mayne Block <br />P.O. Box 175 <br />'osto Gypsum. CO 81637 <br />_ rA <br />s <br />Postage - 3 <br />N <br />'~ <br />CeniLed Fee '. ``~~ <br />~kx..~ ~ <br />Spedal Delivery Fee ~ <br />i <br />~ ENVF~ <br />d Dative <br />+ <br />~ <br />~ <br />, <br />Restricte <br />.I p <br />Retum ReceiPtl <br />e y9a IHI'~ a~ <br />-C <br />. <br />Wlwm d Deta a fad - ~ _ <br />- CA <br />Realm RxMt Sh ~ ylltam, L ~ <br />~ <br />~ o <br />~N M <br />~ <br />DaM,6oddrasee ` M <br /> <br />(_ <br />0 <br />LL <br />N <br />a <br />SENDER: I also wish to receive the <br />r • Complete items tand/or 2 for atltlihnnat services. <br />i IoIIOWing ServiCeS ((df an <br />• Complete items 3. 4a, and 4b <br />• Pnnl yow name and address on the reverse or Ihis form so That we can return Ines <br />extra fee): <br />'. card to yov. <br />~ • Anach this form to the honl of the mailpiece. or on the back if space tloes not <br />1. ^ Addressee's Address ~ <br />i • Write IWdNrn Rece~pl Requesred'on Iha mailpiece below the article number 2. ^ Restricted Delivery m <br />• The Return Receipt will show Ie Whom Ina adicie was tlel <br />i ivered antl the dale COnSlllt ostmaster for fee. <br />p <br />4 <br />de <br />rvereo. <br />i 3. Article Addregsed to: 4a. icl Number <br />I <br />i ~ <br />~ 4b. Service Ty ~ <br />Al r. Roben V. Mayne <br />~ Certified <br />^ Registere to <br />~ <br />Mayne Block ^ Ezpre Y F <br />^ Insured <br />M 5 ~ <br />P.O. Boz 175 27 <br />Gypsum, CO 81637 ^ Retur Re ipl for arch d ^ COD ~ <br /> 7. Dat of el ~~ Q S <br /> <br />C ~p <br /> <br />~ <br />~ <br />T <br />5. R eiv d By: Print Name) 8. Addr Addres it requested ,e <br /> and le p ~, ~ <br /> r <br />6. igna re: (Addre ee or ant/ ~ <br />X v <br />Ps Porm 3811, Decemeer lssa +uzsas ea a-ozzs Domestic Return Receipt <br />