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araeucnc <br />•Complola items 1 and/or 21or additional services. I also wish to receive the <br />•Complele items 3, da, and db. }OIIOWIng serVICBS (fOr 0n <br />• Print your name and atltlress on the reveres of this form so that we can velum this extra fee <br />rartl to you. <br />•Mach this form to the hoot of the mailpiece, or orraie 6arli it space does not 1 <br />~ Addressee's Address <br />• Wn' e~Refum Recei t R ues(ed' °n the mail 'ece below the atlicla number. <br />p eq w . <br />2. ~ Restdcted Delivery d <br />w <br />•ThB Roluin Receipt rill show to whom the aditle was tleliveretl and the dale <br /> <br />delivered. <br />Consult postrnaster for fee. G <br />- <br />MIR RICK IiERGENS <br />COOLEY GRAVEL COIiPANY <br />3605 S TELLER ST <br />LAREflf00D CO 80235 <br />& Signal <br />X~ <br />PS Forth <br /> m <br />4a. Article Number ~ ai <br />-z t4t <br />3 <br />~5r~ r <br />o <br />. <br />4b. Service Type ~ <br />a <br />^ Registered Certified <br /> <br />^ Express Mail [] Insuretl a <br />O Retum Receipt for Merchandise ^ COD <br />7. Date of Delivery <br /> 0 <br /> T <br />8. Addressee's Address (Only i/requested ~ <br />and fee is paw <br />_ ° <br />L <br /> <br />?IPt <br /> <br />e <br />s <br />C <br />n, <br />li <br />d <br />Spec. 'A'DC. r", <br />Z 191 517 13! p ~`~ <br />us Postal ServiceFile # •73 •Q2 <br />Receipt for Certified Mai~'~O L~ <br />No Insurance Coverege Provided. v~'L (,~ <br />Do not use for Intemebpnal Mail See reverse <br />C.a <br />~!°RICR IiERGENS <br />er <br />3605 S.TELLER ST <br />P~235 <br />Pm+ew ; ~~ <br />CerEfietl Fee ~~(,r <br />Speaal Delivery F aSv~ <br />Res'hiped ~ G/ <br />> t~pt % ~ <br />F ~~ <br />DaES,6 AA5eaee's ~ ~~. <br />TDiAL Piufage 8 Fees <br />I ,S ~ , ~~ <br />~ Postmark or Dale <br />Cf1 <br />CD <br />N_ <br />SJ7 <br />C <br />m <br />e <br />a <br />1 <br />1 <br />