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<br /> <br /> <br />m SENDER: <br />v •Camplela items 1 nnNOr 2 for etltlitional services. <br />m •Complete items 3, aa, end ab. <br />e • Pnm your name antl address on the mveree M this form sc Nat we can return this <br />card to you. <br />~ • Mach this lorln to the 1roM of the mailpiec•, or on the back if apace does not <br />~ perrnil. <br />m •WMa'Retum Receipt Requested'on the mailpiece below Ne adide number. <br />C, ~a getum Receipt will show to whom the snide was tlaFveretl and the tlate <br />C tlelivered. <br />v 3. Article Addressed to: 4a. Article D <br />.. 2 ~ ~ <br />d <br />a <br />E 4b. Service <br />0 <br />I also wish to receive the <br />following services (tor an <br />eMra fee): <br /> <br />1. ^ Addressee's Address ai <br /> <br />Z <br />2. ^ Restdcted Delivery rn <br />Consult Postmaster for tae. ° <br />u Mr. Jerry Worthley ^ Registered <br />547 Yale Place, k202 ^ Express Mail <br />,Canon City. CO S 1212 ^ Retlrm Recep <br />n ~. ~ n..._ ..s n_i.... <br />5. <br />6. Signatufey ddress a orAger <br />~ X CXt <br />C <br />PS Fonn 3 1, Dec ber 1994 <br />and lee <br /> Y <br />d <br />3 ~O7a <br />. <br /> 9 <br /> <br />`Rll CeRitied d <br />~ <br />TY C Insured <br />COD m <br />~ <br />V~ N <br />~~~ Nl ~. <br />;YOril i1 eq sled ~ <br />USP`~ ~ <br /> <br />