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m <br />9 <br />O <br />>? <br />c <br />0 <br />9 <br />m <br />a <br />0 <br />v <br />W <br />o' <br />>+ <br />m <br />.Complete Iteme 1 enNw 2 for edtligonN aerviua. <br />•Cadrplele Mama 3, Ia, end Ib. <br />•PriM your name and edtlreae an NB raveru of this Mrm eo ihel we un ratum Ihla <br />•Adech Nie brm ro the Mom of the mellpieu, w on the beck if spec does not <br />permit. <br />•WAIa'Refum Repaipf Requesfed'on the meilpieu below the anida number. <br />.The P.elum Receipt vriN show to whom Me article was delivered antl the dale <br />eelivered. <br />MR COLE PROCTOR <br />PO BOX 344 <br />MeeteR CO 81641 <br />1~R0 ~.~~ <br />I also wish to raceme the <br />lollowing services (tor an <br />extra fee): <br /> <br />1. ^ Addressee's Address rY <br />~ <br />2. ^ Restdcted Delivery y <br />Consult postmaster for fee. ~ <br />^ Registered <br />^ Express Mail <br />^ ReNm Racey'~t~fyor M <br />7. Doty ~ 1 8 0 <br />i o <br />8. Atldressee' ddress <br />end lee is peld) <br />1025959]-eOt]9 Domestic <br />6. Signature: (Addressee arAgen <br />X <br />PS Form 3811, December t99a <br />u <br />°o <br />a <br />C <br />4 <br />P <br />i <br />u <br />U <br />e <br />~ 436 789 309 <br />_ Spec ~~_ <br />US Postal Service <br />Receipt for ~f~d Mail <br />No Insurance Coverage Provided. c~ <br />n~ nm ~~eo inr Intamatinnal Mail /See reveller" <br />~MR COLE PROCTOR <br />PO Box 344 <br />MEet,~ERCO 81(x11 <br />r w ........... ......... .. ur ..w• <br />Ppstage <br />Certified Fee ~ <br />Spedel Delivery Fee <br />Resldded Delivery Fee <br />Retum Receipt Shoeing b /~ <br />~ <br />Whom d Date De4verad - :f. ' <br />7 <br />Remm Resiq Sfnwtq to !"\ <br />, <br />Date,B pddessees ldA ~•r O <br />TOTAL Postage 6 es a (C _:. r <br />Posenark or Date C ~ % i ~ ~ <br />s ~ / JI <br /> <br />3b9 e <br />Certified <br />^ Insured e <br />^ COD <br />0 <br />0 <br />T <br />rl requested ~ . <br />t <br />r <br />