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' Z 583 623 655 <br /> US Postal Service <br /> Receipt for Certified Mail <br /> No Insurance Coverage Provided. <br /> Do not use for International Mail See reverse) <br /> 5 to E J <br /> Streel8 N_um e <br /> I Z <br /> Post office.Stat9.8 ZIP Code <br /> Postage $ <br /> Certified Fee t <br /> Special Delivery Fee J <br /> Resinaed Delivery Fee <br /> rn Return Receipt Showing to <br /> Whom 8 Date Delivered <br /> a Rehm Recapt5riawingto Whom, <br /> Date,d Addressee's Address <br /> G <br /> Om TOTAL Postage 8 Fees $ <br /> 0 Postmark or Date <br /> o <br /> a <br /> ai SENDER: I also wish to receive the <br /> V •Complete items 1 anU.'or 2 for additional services.m following SefVtCeS(for an.Complete items 3,4a.and 4b. <br /> w •Print your name and address on the reverse of this form so that we can return this extra fee): <br /> card to you <br /> N •Affach this form to the front of the Tailpiece,or on the back it space does not 1,❑ Addressee's Address <br /> perms. 2.❑ Restricted Delivery N <br /> L •Write'Return Receipt w l show to w on the ma icle w below the article number. ry <br /> •The Return Receipt will show to whom the aside was delivered and the date postmaster ostmaster for fee. <br /> delivered n <br /> 0 3.Article Addressed to: 4a.Article Number u <br /> d Fort Collins SCD Z 533 623 655 E <br /> a 41b. Service Type <br /> 141S N. College Ave. , #3 ❑ Registered IR CertifiedIr <br /> ❑ Express Mail ❑ Insured 0 <br /> Ft. O 80524 <br /> Collins,' ❑ Return Receipt for Merchandise ❑ COD <br /> cc <br /> 7. Date o1 Delivery <br /> o o <br /> 5. Received By: (Print Name) 8.Addressee's Address(Only if requested s <br /> and fee is paid) m <br /> c <br /> 6.Sign e: (Addresse or nt) 98.273 ~ <br /> 5 <br /> PS Form 3811,D emb r 99 102595-98-80229 Domestic Return Receipt <br />