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9 •Complete items 1 and/or 2 for additional services. - I also wish to receive the <br /> o aCorrplele items 3,4a,and 4b. following services(for an <br /> 0 ..Prim your name end address on the teveree of this torte so that we can return this extra fee): <br /> card to you. <br /> omach this to to the from of the mailpiece,or on the bed{j/space-do3v not 7, ❑ Addressee's Address <br /> sWrile-Relum Receipt Requested' the mall piece below the article number. w <br /> o a eQ c 2. ❑ Restricted Delivery alhe Return Receipt will show to whom the article was delivered end the date co <br /> u delivered. Consult postmaster for fee. L <br /> 'm <br /> w 3.Article Addressed to: -- — 4a,Article Number 6 <br /> Z tl (/In c <br /> 4b.Service Type <br /> BACA COUNTY BOARD OF COMM ❑ Registered ert6ed rn <br /> P 0 BOX 116 ❑ Express Mail ❑ Insured n <br /> SPRINGFIELD CO 81073 1TAetum Receipt for Merchandise ❑ COD <br /> 7.Date-IDelivery <br /> 0 <br /> r <br /> 5.Received By: (Print Name) 8.Addressee's Address(Only if requested � <br /> and fee is paid) a <br /> r <br /> g 6.Signature ddressee or ent) <br /> a° X <br /> e <br /> PS Fo 3811, cembe 1es4 Domestic Return Receipt <br /> Z 4C$7 <br /> r' Fdec�rult�-�S lco <br /> o * P# <br /> Rertio <br /> N MFail <br /> No Insurance Coveralw'+4u p) <br /> iwr. s Do not use for International Mail <br /> (See Reverse) <br /> BACA COUNTY BOARD OF COMM <br /> P 0 BOX 116 <br /> SPRINGFIELD CO 81073 <br /> uv <br /> Ceridre Kee <br /> Specai orlivery Fee <br /> Restnc;dd Delivery F" <br /> E eelur0 Ac¢DI SM1pwmg <br /> ` io WM1Dri 8 Dare De4ve¢tl <br /> LRemm neceipr Snpwmg m WM1om. <br /> C De re.arlp Addreseee'5 Address <br /> TOTAL rosiage �♦ <br /> f. It fees <br /> �r Posurmarj or Dar r� `\� <br />