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e <br />I°_ <br />0 <br />E <br />5 <br />0 <br />r <br />e <br />:Ccrnprna iterrn 1 anNor 2 ror edAtlonel asmcea. I also vAsh to receive the <br />.compete ttane s. 4a, erd fib. follovdng services (Tor an <br />^Pdm your name end eddreaa an the rewne or Nle roan ao dlatwa can rahan flue e%Va }66)' <br />uM to you. <br />.Mach NV brm to trq kom of tM rrWlpiea, or an sr Deck it epsce <br />pemut. <br />•Write'Retum Receipt Repueated'on the mailpieea Debw the ardds <br />eThe Retum RBCelpl will atawto whom d1a arlids was derivered BrM <br />delivered. <br />3. Article Addressed to <br />EMPLOYERS MUTUAL CASUALTY CO <br />P.O. BOX 441098 <br />AURORA CO 80044 <br /> <br />aoa. nm 1. ^ Addressee's Address <br />number 2. ^ Restricted Delivery rpi <br />the date <br />Consult postmaster for fee. ~ <br /> <br />Artlcle Number <br />~'~ 3 ~0 789 3a `{ <br />4b. SerWCe Type <br />Y <br />^ Registered ~Cerbfletl o <br /> <br />^ 6cpress Mall ^ Insured r <br />E <br /> <br />^ RetumReceipllorMerdrarttllse ^ COD e) <br />7. Date of Delivery +° <br />/D-~(o-O[J ~ <br />a°. <br />B. Addressee's Address (Onty it requested ~ <br />• and fee is paid) 9 <br />or <br />PS Form 3871, December 1994 <br />El <br />P. <br />A' <br />m <br />_rn <br />c <br />G <br />O <br />m <br />0 <br />LL <br />V) <br />a <br />10Y59Cr97~a-0179 <br />P 436 789 324 A~p9f5t/ <br />US Postal Service ~~' <br />Receipt for Ciq fledIr~1A i <br />No Insurance Coverage~rovidaiod ~0(~ <br />Do not use for International Mail See reverse r~ <br />tlo_ ----- --- <br />e1PLOYERS MUTUAL CASUALTY CO <br />0. BOX 441098 <br />JRORA CO 80044 <br />Postage S <br />Certified Fee a <br /> ' <br />Spatial DelNery Fee <br />Restdded DeG <br />~~ <br />t <br />8 <br />Rehm n <br />When Gvared <br />~ ~~ <br />Rebm <br />Dale, s <br />TOTA e 8 Fees <br />Posana <br />Q <br />C <br />f` <br />r <br /> <br />