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v SENDER: I also wish to receive the <br /> C •Complete items l and/or 2 for additional services. IOIIOWin SerVICCS(for an <br /> 'rn •Complete items 3.4a,and 4b 9 <br /> m •Print your name and address on the reverse of this form so that we can return this extra Fee): <br /> .�. card to yyou. U <br /> c' •Attach Il is torm to the front of the malpiece.or on the back it space does not 1.❑ Addressee's Address <br /> Write permit. 2.[I Restricted Delive m <br /> m •Write"Aelum Receipt Requested"On the mailpiece below the ankle number. Delivery N <br /> y •The Return Receipt will show to whom the article was delivered and the date Or(SUII postmaster for tee. <br /> delivered. C P a <br /> 0 3.Article Addressed to: 4a.Article Number <br /> d <br /> 04V 90 M7 X <br /> n 4b.Service Type 5 <br /> E Mr.Pal Bolli 'm <br /> 6 ❑ Registered '63 Certified <br /> to+ Ibert County w <br /> .O. Box 7 ❑ Express M ❑ Insured 5 <br /> 7(iowa,CO 80117 ❑ Return ❑ COD 0 <br /> 7. Da/VWKery o <br /> 0 <br /> o _ <br /> 5. Received By (Print!Jame) &.A e9MYAqVr1,1;sZQ0Ujfr quested x <br /> a fee is paid) m <br /> 6.Signature: dres a rAgenq ~ <br /> V ~ <br /> 0 <br /> T <br /> =e PS Forcn 3811,December 1994 102595 9".0229 Domestic-Return Receipt <br /> 1 <br /> P 436 7`t$ c� <br /> t o <br /> Z US Postal Service p <br /> I N, Receipt for Certifi Mal '°y °a <br /> IrNo Insurance Coverage Provid O <br /> T Do not use for International Mail Se verse <br /> V1 sent to \ <br /> Mr.Pat Bolligy <br /> S rest&Nur Elbert County C <br /> P.O. Box 7 <br /> Post " Kiowa,CO 80117 -27 <br /> _ <br /> rpY1 <br /> i Postage $ , <br /> �T t Cediged Fee ( <br /> special Delivery fee C <br /> r Restricted Delivery Fee <br /> ` Whom <br /> RetumIt Date Receipt Showing to <br /> Whom It Date Delive e, Ek � d` <br /> Dale,&Pddrtssae's .— <br /> i[m TOTAL Postage& $19 a 8 <br /> Posrtnark or Date r 0� <br /> l� L6Ps <br /> I <br />