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sss ~~ <br />^ Complete kerns 1, 2, and 3. Also complete <br />kem 4 k Restricted Delivery is desired. <br />^ Print your name and address on the reverse <br />so that we can return the card to you. <br />^ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />I <br />Alpine Bank Carbondale <br />3050 Hwy. 133 <br />Carbondale, CO 81623 <br /> <br />/~l'~/~~oo~- d~ 3 <br />~~~ ~ ~ <br />~~ ~~~~ . . <br />~ Cdr/ ~~. ~ s-~~ <br />~~ ~~~ <br />r ~~~ <br />~ ~ <br />A <br />B. Aecelved by (Pnrrted Name) <br />L7 Agent <br />D. Is delivery edtlress different from kem 1? ^ Yes <br />If YES, enter delivery address below: ^ No <br />3. <br />~Certifled Mall ^ Express Mail <br />^ Registered ^ Return Receipt for Merohandise <br />4. Resbic[ed DaliverJl (Extra Fee) ^ y~ <br />2. ArtldeNUmber 7004 1350 0001 2636 6546 ' <br />(rianslerlrom service IabafJ <br />PS Forth 3811; February.2004 Domestic Return Receipt tozsssaz-m-tsao <br />.n e <br />I • • f .1 . <br />° ,. <br />~ ~i P_ <br />m {iJ ~ r <br />..a - <br />~ - -- <br />$ .39 _- <br />,a Postage: <br />o° Certified Fee: /'$2.40__ ~~, <br />o (FStlors Kelton Receipt Fee: $1 SSdsr, -,; <br />~ , <br />O Restric ~ ~S 4PR~ ° ~~ <br />m fEad°~ Tntal Posetaee Bc Fee... 4.hdj2, ~ ~ . <br />'~ Total Postage S Fsea I y 1~- '11!10 ~ <br />o ~" ° Alpine Bank Carbondale <br />r 3`tree6 ~tvi-Tfo.j -------- 3050 Hwy. 133 ~ -•---- <br />orPOBOxNO. ~ ~ <br />am;~;na:------- Carbondale, CO''81623 -•---•- <br />„ <br />