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,. ...,., <br />S <br />u <br />0 <br />a <br />5 <br />s <br />n <br />c <br />r <br />r <br />i <br />a <br />. i <br />C <br />9 <br />C <br />n <br />C <br />i <br />C <br />r <br />S'u~PFA: Canpleb uevu 1, 3, and ]. <br />Add your addre[a b Ne `RETURN ~70` Ran on <br />wvenn <br />1. The faOawing cerri« n requested (check oney~~~ `Ma <br />~ Shnw to a•F.om and date delivered............ _ t <br />^ 6how to whom, date and addrw of deljvery:..:~C <br />^ RES7'itICTF.D DEWERY ~ ~ ~ <br />t <br />Shaw to whom and date deliwred....~t.~:~3. I--< <br />^ RFSERICIED DEI]VERY. t .~~ <br />Show to whom, tLite, and addreo of delivery:f~. <br />(COh5U1rT POS:2dA5TER FOR fCES) <br />2 ARTICLEALDREEl.LOTO: Ms. Patsy I. Fry <br />Insurance Administrator, <br />Schmidt-Tiago Construction Co. <br />P. 0. Box 487, Arvada, Co. 80001 <br />1 ARTICLE uEbCRNTiJN: <br />PEGIbTlRED NO. ~ CERTIFIED NO. INSURED NO, <br />,~03 8718230 <br />~,tlwaya obtain narutun of addreaaa ar aL~nU <br />!have realved the ankle deurlbed above. r <br />b10tMTLRE ^Addreaaes pAUmod,<d.p:t <br /> <br /> <br />DA OELR/E Y <br />j r <br />S ADDRELS ICampYb an1Y B ~ G <br />v`/~ <br />i & UNAjjIE TO DEINkR BCGUCE: a0 b <br />t ~' INITIAL! <br />Y(GpO: t~1E00 669 <br />1 <br />r., <br />I <br />P03 ~ i.t8i;?~' <br />RECEIPT FOR CERTIFIED MAIL ~ <br />~ ND INSURANCE CDVEflAGE PflOVIDEO- <br />~ NOT FOfl INTEflNATIDNAL MAIL <br />~ (See Reverse) <br />m SLN1D Ms. Patsy I. Fry <br />'~ Insurance Administrator <br />=1mrrA.,Dr+c Schmidt-Tiago <br />c Construction Co., Box .487 <br />N PII ..STATE ANUIP COUE <br /> <br />N M5 14G E <br />U <br />I ~ GE RiIR ED FEE <br />I N <br />~ n <br />LL <br />SPECIAL OELIVERV <br /> RESrRICtED DELNEnv <br />Q ,. <br />ILA ¢ ,,, v~nw lowHOre AUn <br /> w <br />~ v pelf 111 UVEFEU <br />I <br />f <br />w z <br />$HUW IU WHOM. HAtE. <br />~' <br /> Aqp ApUaE$$UE <br />~ <br />Q) S ¢ prl ivEPv <br />~' <br />O <br />~ o_ '-'„ SIpW IU WNOM AvU ~ <br /> <br />a pCt NEFEO Wi1H N61 <br /> w <br />z o z UE IIVEav <br />s .. <br /> ~+ ° $HpVl 10 WHOM DAtE <br />E ~ Apnnts$~r p[wte: <br />,~ P[,aM1LU UE UVEHv <br />P '~ <br />- TOTAL pObiAdfANDlt~>~ <br /> a <br /> -- _ <br /> __ a <br /> t <br /> t <br />P4 __ <br />IUE 6 <br /> <br />a;nH t <br /> <br /> s l g <br />~ pObTMARK OI(DATE `a• <br />C 1 vT~ <br />.~ <br />E ._. <br />`o <br />LL <br />!n <br />d <br />