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"•' SENDER: - ~~ <br />t7' .Gbmplele ilams 1 andlor2 for addhiorW aeMws. - <br />n s(:pmplete name 3, 4a. BrM 16. - - ~ I:.r, <br />:Pool your name arM address on the reverse of this fotrrl eo tllal we can return this <br />card to you. <br />y aAtlach Chia Corm to the hoM of the mailpiew, or an the back i1~6pew tloee not <br />m pgrmil. ~ ~ <br />m ~ Write'Aefum Aece/pr Repuesred' on the rnailpiew below Ne article number, <br />« .The Return Receipt will ehpw to wtwm the snide was delivered end the date <br />~ delivered. <br />0 <br />~ 3. Article Addressed to: _ - _ __ _ _ 4a.,A~iclg T <br />d L (~_~ <br />n <br />fi b. Service <br />I also wish to receive the <br />following services (for an <br />extra tee): <br /> <br />1. ~ Addressee's Address u . <br />~~ <br />2. f7 Restdcted Delivery m <br />Consult possnaster for tee, m ~ <br />e <br />p <br />g~ <br />~ <br />tp <br />a <br /> <br />o <br />~ BACA COUNTY BOARD OF COMM 7 Registered 'Certified <br /> P 0 BOX 11b ]Express Mail ^ Insured 5 " <br /> SPRINGFIELD CO B1073~etumReceipttorMerdandise ^ Coo ' <br />c <br />~ Date of Del' ery <br />z ~, <br /> 5. Received By: (Pdnf Name) 8. Addressee's Address (Onlyil requested ~ <br /> and lee is paid) c <br /> f <br />~ fi. Signature: ( dres a orA nt) _ <br />°a. X <br />~ <br />a Ps F 3811, De b ssa - - Domestic Return Receipt <br /> /~ ~ <br />l ~ ~'L U~~~~j <br />c-~ R f _ f_ <br />° ~ Certifie <br />CV <br />~ ~ No Insurance Covera~-~io~i~3'f~t <br />,o uy~ Do not use for In[ernanonal Maily <br />A____ _-1SeeAeversel_ ._ _ __ - <br />BACA COUNTY BOARD OF COMM <br />P O BOX iib <br />SPRINGFIELD CO 81073 <br />A <br /> Cerot~ep Fee <br /> SOeaal Delrv¢ry F¢e <br /> PeSlrKled DelhgrY Fee ~ _ _ - _ <br />y Return Reca~pl Showing • <br /> to Whom & Daie DeLVereO <br /> Return Receipt $hpwmg 1o Whom, <br />' <br /> Dale, arts Aaa~essee <br />s mess <br />f TOTAL Posiag n <br /> <br />6 Fees <br />~~ <br />~ Postmark r D e <br /> <br /> p <br /> ~, <br /> <br />