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m - <br />m <br />m <br />m Rnslage s <br />a- <br />~ CeMhetl Fee <br />s Return Recei0l Fee <br />~ (Entlorsamem Required) <br />O <br />p Restncled Oel,ve<y Fce <br /> 16rtlgrsemenl Requiretl <br />O <br />p Total Postage 8 Fees ; <br />S <br />m Narne (Please Pn'nl Clearly) <br />o,. _ Gtll_d_____I< h <br />_~s........ <br />~, Slrret, ApG No , or O Box <br />~"j0 Postmark <br />J Here <br />~r}5 *Q` <br />C JJ <br />V <br />..~~ (~Yf 4.~. Y4.::1............ <br />t• City Sf le, ZIP.4 <br />~:t~_~e.., co ~~1y33 <br />^ Complete items 1, 2, and 3. Also complete <br />item 4 if 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 it space permits. <br />r. Article Addressed to: <br />A. <br />^ Agent <br />B. R~ved by{ Pnnred Na C.~te of Delivery I <br />t ~ >~/c13 <br />D. Is delivery adtlress diflerenl from item 17 ^ Yes <br />If YES, enter delivery address below: ^ No <br />e ~ 4 3 ~ 3. Service Type <br />BCertified Mail ^ Express Mail <br />^ Registered ^ Return Receipt for Merchandise <br />^ Insuretl Mail ^ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ^ Yes <br />2. Article Number > OS C ~~D Cfrl <br />(Fransler //om service label) ~: T- i 1 I ., y. ,~' `~ 3 ~ S ~ 3 3, <br />PS Form 3811, August 2007 ~ Domestic Return Receipt tozsgs-0z-tn~toa <br />