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UN <br /> Compote Name 1 and/or 2 for arfdtlaW"Move. I also wish to receive the <br /> • aComplate gems 3.42,are m. following services(for an <br /> 0Pdn your name and address on the ravens of this form ao that we can relum tNa extra fee): <br /> card to aAaadh this to the fore of the mallplad,or art the Deck x sped does nott. 8 <br /> > 1. ❑ Addressee's Address 'c <br /> = Arite-Ratum Raoa/pt Requested'on the maill d below the adioN 2 <br /> MONW. oG <br /> sThe Retum Receipt will Show to whom the artlde wall delivered ant lM data . ❑ Restricted Delivery 1rj <br /> rfslbered. w Consult postmaster for fee. � <br /> o <br /> 3.aNcle Addressed to: 4e.Article Number <br /> _ Z 434 941 574 <br /> Ms Mary Seifert c <br /> n Mike Colemand and Jerry Seifert 4b.Service Type o <br /> 60160 Hwy 69 N (3 Registered ] Certified <br /> ra <br /> Westcliffe CO 81252 ❑ Express Mail ❑ Insured 5 <br /> • <br /> ❑ Return &Xa ss ❑ COD <br /> r7.Date ery <br /> 0 <br /> N r <br /> 5.Received By:(Pdnt Name) 8. ( f requested <br /> i mod) J <br /> c 6.Signs! r d ssee or Agent) ,J1 <br /> > X G S3M <br /> • <br /> Ps Form 3811, Clecernber 1964 k 1102595.97-11-0179, Domestic Retum Receipt <br /> Spy S�j <br /> Z 434 9A-& <br /> l!S Postal Service <br /> Aeceipt for CertifiedllAa�i( Z?Ls <br /> No Insurance Coverage Provided. L: <br /> Do not use for International Mail See reverse <br /> 34JtoMary Seifert art <br /> %WmMy 69 N ll <br /> Post otfid,State,S ZIP Cade 7 <br /> Westcliffe CO 81252A <br /> Postage 3 <br /> Cer6Ged Fee f Q <br /> $pedal Delivery Fee <br /> C <br /> Restricted Delivery Fee 63 <br /> N <br /> m Retum Receipt Showing to UO <br /> Whom b Date Delivered 7vt cues <br /> 'a Realm Receipt Sharing to S� '••� <br /> Dale,&Addressee's Adders Q. M <br /> r <br /> TOTAL Postage d Fees $00 <br /> Posonark tar Date \ v ��r <br /> rat <br /> a <br />