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~ • r7~r tsee~ 1 enNar 2 Nr eMWar~l esdws, <br />~ • CrAlw Reim 3, and ee a D. ~ <br />•s • tMnt ytrur name end address on the reverse o(thb form ao that we can <br />relWA t11ie qN to You. <br />~areyizn to me Iront of the mevD9eoa or m the bePk p ewae <br />• Wrire"pserm fNwiptpequasted"onthe oa~i~bebwtbeeNCN numbs <br />_ • 1TM paNm Receipt will snow to wrwmlM Onidewee deliveredueiMe del <br />to: <br />FREMONT COUNTY BOARD OF COMM <br />615 MACON AVE ROOM B-5 <br />CANON CITY CO 81212 <br /> <br />1 also wish to receive the <br />following services (for an extra Y <br />feet: Z <br />t. d'Addressee's )rddress y° <br />2. ~ Restricted D~'FVary <br />Consult yostmes~er }or tee. o <br />le Number C <br />ala -1G1 o?~tc 3 <br />ce Type <br />U Registered ^ Insured <br />0,' e, <br />Certified ^ COD ,$ <br />^ Express Meil ~{Aeturn Receipt for <br />Merchandise <br />7. Date f Delivery ~ <br />and fee is paid) <br /> <br />P 296 797 226 <br />RecL~i~F ~' <br />Cer~t~~~ p~~~ <br />co <br />N Do not use for International Mail <br />p (See Reversal <br />~ Sam m <br />FREMONT COUNTY 80ARD OF COMh <br />615 MACON AVE ROOM B-5 <br />CANON CITY CO B1A'~lc <br /> <br />_ Cernr~etl Fee <br />r_ <br /> <br />N $peoyl pelnery Fe <br /> <br /> Reav¢retl Oe~werv Fee <br />~ feral 8 Geoloyy <br /> Return eczipr $rrpy rg <br />Ip Wnom q Oa .even <br /> Aelurn R¢C¢~ 1 $ ra NTom <br />+_C Dare, aPtl AUpiess¢e r pUtlr¢se <br />t *Or AI Poerege <br />(~ B Fees C <br />Ponmark or pate <br />