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<br />DERIVEF3 <br />OFFfCE <br />_~ <br />L <br />4 <br />O <br />O <br />IL <br />a <br />M1 <br />~ SENDER: <br />'y • Complete items 1 end/or Z for additional services. <br />m Complecc items 3, •rM 4. 6 b. <br />~ • Print your name and address on the reverse of this lorm so That we can <br />~ return this card to You. <br />m • Attach this form to the Irons of the mailpiece, ar on the back it space <br />does not permit. <br />L • Write "Return Receipt Requested" on the mailpiece below the article number <br />• The Return Receipt will show rp wham the article was delivered end [he date <br />~ delivered. <br />v 3. Article Addressed to: 4a. Article Number <br />m Z o s 2 y98 <br />& Raymond Kel th 4b. Service Type <br /> P _ D _ BOX 1011 ^ Registered ^ Insured <br />y Mancos, CD 8132$ ®Certified ^ COD <br />w ^ Express Mail ^ Return Receipt fo <br />S rC ise <br />~ 7. Date of Delive %'`,. <br /> P <br />2 5. SI tuts (Addressee) ~ <br />~ R. Addressee' ~ sJ9r,~y~{f Equested <br />and fee is iii ~ <br />~ Q J <br />~ 6. Signature (Agent) <br />7 <br />O <br />Z X52 978 906 <br />Receipt for <br />Certified Rflail <br />No Insurance Coverage Provided <br />Do not use for International Mail <br />~,us~ ISee Reverses <br />Raymond Keith <br />P_O. Box 1011 <br />Mancos, CO 81325 <br /> <br />Postage h <br />V <br />Carulietl FM <br />Sce<~al Delivery Fee <br />Pestricled Delivery Fee <br />flewrn Racapr Showing <br />to Whom 6 Date Dehvered ~ . , <br />Retum Rece~pl Show to WMm, <br />Dais. antl Atl s <br />TOTAL P age ~ <br />a Fees ~ ~. [' <br />J <br />Poslm L <br />4 ~I\~ Jn <br />N ~~ p <br />~ p £~°' <br />I also wish to receive the <br />following services Ifor en extra <br />feel: <br />1. ^ Addressee's Address <br />2. ^ Restricted Delivery <br />0 <br />v <br />.~ <br />N <br />d <br />'m <br />V <br />R <br />E <br />m <br /> <br />a` <br />rr <br />Y <br />c <br />m <br />F=- <br />~ PS Form 3871, December 1991 nu.s.oPO:taxr~szatb DOMESTIC RETURN RECEIPT <br />