PERMFILE59479

• Permit No: M1977129
• IBM Index Class Name: Permit File
• Doc Date: 8/10/1977
• Doc Name: RECEIPT FOR CERT MAIL
• Media Type: D
• Archive: No

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Add your eddrtse iP the "IIHTURN 70" rpACe on
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1. The tdknyinE aetvige it nquested (cheek one). '
Show to whom and date deEveted.........._. 15{
Show to whom, date, R addttu o{ delivery.. 95{
RESTRICTED I~:IT{~iLY.
Show to whom. } _ t7Ad'.
~ dtk a °--._..... 65{
RESTRICTED D~L7 Y,
Show to whom, date;~p6d~ten of delivery 85{
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t. ARTICLE ADDRE•orn M:
A. P. Forsgren
3209 C Road
Whitewater, CO 81527
3. ARTICLE OESCRI/T10N:
REGISTERED NO. CERTIFIED NO. INSURED NO.
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I have txeived the artiele derribed above.
SIGNATURE ^ Addresece ^ Authoriad

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D11TE OF DELIVERY

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1. The fdlowin3 rervitx u requested (check one).
Show ro whom and date deRveted............ IS{
Show to wham, date, ~ addterr oT delivery.. 35{
RESTRICTED DELIVERY.
Show to whom and date delivered ............. 65{
RESTRICTED DELIVERY.
Show to whom, date, and addtest of delivery BS{
Z. ARTICLE ADDR ID:
B. P. orsgren
3209 C Road
Whitewater, CO 81527
3. ARTICLE DESCRIITION:
REGISTERED NO. CERTIFIED NO. INSURED NO.
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I have received the artir•1e desenbed above.
SIGNATURE ^ Addrelece ^ Authoriud agent
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RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PRDVIOER-
NUT FOR INTERNATIONAL MAIL
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