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^ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />^ Print your name and address on the reverse <br />so that we can return the card to you. <br />^ Attach this card to the back of the mailpiece <br />or on the front if space permits. <br />1. Article Addressed to: <br />Douglas Kahanek ' <br />PO Box 265 <br />Signature <br />(Prln <br />.~ <br />Agent <br />Addressee <br />D. Is delivery add ~ rfferen _ 1? L`] lte: <br />If YES, enter ivery as ^ No <br />R( a ~ <br />h_• <br />Florence CO 81226-0265 3. Servioerype --~ <br />~ ^ Certified Mail ^ Express Mail <br />^ Registered ^ Retum Receipt for Merchandise <br />^ Insured Mail ^ C.O.D. <br />4. Restricted DelNer)/J (Extra Fee) ^ Yes <br />2. ~ cl~r fromservlce labeq <br />: PS Form 3811, February 2004 Domestic Retum Receipt iozsss-0z-M•tsao <br />