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~- <br />tix <br />f~ <br />r <br />r <br />r <br />r <br />i <br />~~ f <br />0 <br />T <br />No itetm 1 and/or 2 for edditforiel services. <br />ale ileen 3, /e, erM IU. <br />wr name end address on the nvons of Via brm so Nat rre ran Mum thls <br />you. <br />this form fo fho frorrt d tho mdlpaoo, or m the back it apap does rat <br />tW' on the mearyece bebw the adiclo number. <br />to whom tlu elide wee deNveretl and the data <br />Weststar Ban}; Of Delta <br />488 Hwy 92 <br />Delta, CO 81416 <br />1 oleo wish to receive the <br />fdbwing services (for an <br />extra fee): <br />1. ^ Addressee's Address <br />2. ^ Restrtged Delivery <br />Consult postmaster for fee. <br /> <br />rpe <br />^ Registered ~ Certillsd 2 <br />^ Express Meii ^ Insured = <br />^ ReNm Receipt for Metchandse ^ COD <br />7. Date of Delivery ~ <br />8. Addressee's Address (Only i/ requested Y <br />end leers paid) <br />100aa.e1$017G <br />