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o SENDER: <br /> a aComplete item 1 wd(or 2 for additional services. I also wish to receive the <br /> m a Print yo fdbwi services(for an <br /> your nammidrm e u address on the reverse of this to"so that we can(alum this extra fee <br /> m card to you. ): ci <br /> Y -Ado'this form to the horn of the mmlpiece,or on the back it space does not t, ❑ Addressee's Address Z <br /> Pe m <br /> .Wri e'RBfum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery m <br /> -The Return Receipt will show to whom the article"a delivered and the date <br /> delivered. Consult postmaster tar fee. ° <br /> O m <br /> v 3.Article Addressed to: 4a.Article Number <br /> v <br /> E MR RICHARD MERGENS 4b.Service TyPe d <br /> COOLEY GRAVEL COMPANY ❑ Regi;lQr d Certified W <br /> m 3605 S TELLER ST ❑ ExpreMail /❑ Insured m <br /> LAKEWOOD CO 80235 i] RetumtRaceipt for Merchandise ❑ COD o <br /> a 7.Date of Delivery 2 <br /> 0 <br /> a <br /> 6. Received By:(Print Name) S.Addressee's Address(Only it requested <br /> w and fee is paid) i <br /> H <br /> 6.Signature: (Addra ee or Agent <br /> x m e X/< <br /> PS Form 3811,December 1994 S C B Domestic Retum Receipt <br /> Z 19MS-742 <br /> C �z <br /> us Postal service File # <br /> Receipt for Certified Maih`�4eP�' , - <br /> No Insurance Coverage Provided. <br /> Do not use for International Mail(See reverse <br /> Sam 1 l: <br /> MR RicHARD MERGENS (✓ <br /> Seel COOLEY GRAVEL COMPANY <br /> CD <br /> Post t 3605 S TELLER ST <br /> LAKEWOOD Co 80235 P' <br /> J <br /> Postage $ <br /> Certified Fee 1�• �, �C�, t <br /> t <br /> Speclal Delivery F 1J � 1 <br /> Rrt54icled DaGvery F v � <br /> N CID <br /> - <br /> � Return Reoeipt Shovdng to " i L <br /> _ Whom&Dale Delivered <br /> � Psean RsroPtSMar9blYtiom, <br /> Dale,A Addresses§Address C <br /> 0 TOTAL Postage li � '/ <br /> Fees s C <br /> cc <br /> I- Postmark or Date C <br /> o � <br /> N IL <br /> a <br /> I <br />