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SENDER: <br /> w .Compete items t and/or 2 for additional services. I also wish to receive the <br /> m -Complete items 3,4a,and 4b. following services(for an <br /> m <br /> •Prim your name and address on the reverse of this form so that we can return this extra fe0): <br /> card to you. rQ <br /> m •Mask;this form to the from of the maitpieca,or on the bad if space does not 1. ❑ Addressee's Address Z <br /> y •Write'Retum Receipt Requesfeo'an the madpece below Ne article number. 2. ❑ Restricted Delivery y <br /> c •The Return Receipt will show to whom the article was delivered and the date <br /> delivered. Consult postmaster for fee. a <br /> o w <br /> 3.Article Addressed to: 4a.Article Number <br /> Z t-4 to Qua <br /> E 14R CHARLES DEVEREAUX 41b.Service Type -10 <br /> 0 925 7TH ST <br /> 0 ❑ Registered Certified <br /> P 0 BOX 228 ❑ Express Mail ❑ Insured .5 <br /> W MEEKER CO 81641 <br /> Retum Receipt for Merchandise ❑ COD 0 <br /> 7'Date of Delivery $ <br /> Received B :(P ' t Name) 8.Addressee's Address(Only if requested <br /> w .i and too is paid) c <br /> ICE <br /> F <br /> 9 'Signature:(Addressee o A enf) <br /> i X <br /> m <br /> PS Form 3811, December 1994 Domestic Return Receipt <br /> Z 416 942 558 <br /> ance rger ided <br /> (See Rever r"a Mail^ <br /> (See X!) <br /> ch <br /> �, Sem <br /> MR CHARLES DEVEREAUX Ca <br /> �J <br /> 5925nd7TH ST w <br /> m <br /> ❑f lore.Mi M_�- <br /> 0 <br /> MEEKER CO 81641 <br /> C0 Postage � -� <br /> m <br /> M <br /> G CelnLed Fee — <br /> O <br /> W 5pe .J Danvers Fee <br /> 1 <br /> Resucteo DM.,ery F. <br /> .A <br /> Return RCCeIDI Showing <br /> io Whom B Oaie DeLvli ( _ <br /> Rewrn Recemt Show r -,,o v 3a D <br /> Dale.am Atltlress¢P� <br /> TOTAL Postage <br /> 1,Fees t a <br /> Postmark or Da <br />