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SENDER: <br /> e I also wish to receive the Z 130 0 6 9 0 � <br /> 9 •Comdata items 1 and/or 2 f«additional ices.sery <br /> e eComd6te items 3.4a,and 4b. following services(for an pee. <br /> we •Print your name and address on the reverse of this tone so that we can return this extra fee): I US Postal service `1 <br /> e Slo hhreafarm to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address = Receipt for Certi�i�d Maid��n� <br /> Pont12 . w No Insurance Coveragb�rovid� <br /> p §"*'RWUM Racsipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N , Do not use for International Mail See reverse <br /> L. eThe Felum Receipt will show to whom the article was delivered and the data <br /> c delivered. Consult postmaster for fee Ms.Carolyn Clemens. .v <br /> S.Article Addressed to: 4a.Article Number ¢ Delta County G)1� ! 501 Palmer Street,Suite 227 <br /> Z i.Jv , Peen Delta.CO 81416 W <br /> Service Type <br /> Ms.Carolyn Clemens 4b. in <br /> Delta County ❑ Registered 10 Certified Posy W <br /> 501 Palmer Street,Suite 227 ❑ Express Mall ❑ Insured S S =r <br /> CD <br /> Delta,CO 81416 ❑ Return Receipt for Merchandise ❑ COD ' Certilled Fee <br /> 7.Date of Delivery E <br /> e Special Delivery Fee 7 <br /> p� T <br /> 5.eeceived Rv:.(,aripi.N�me_f 9.AQdresseWs Address(Only if requested Restricted Delivery Fee :13 <br /> 'lee is p "d) Ar m 3 <br /> all F m Return Receipt Stowing to <br /> p6. l A B y _ Whom d Date Delivered N <br /> i 2 Rehm Rao spit 90 iq ro Whom, 1 <br /> Ia. O Date,A Addres es's Address <br /> � Ps rm , Decemft-tg!04�` _mestic Return Receipt m TOTAL Postage&Fees $ 0 <br /> _ + M Posbnark or Dee, <br /> i CD <br /> a n <br /> 0 <br />