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Ln (Domestic Mail Only, No <br />Insuranc e Coverage Provide"t, <br /> . -. .. , , <br /> A <br />-n L4QFW-a1 C1A L USE <br />Co <br /> <br />cc <br />ru <br />Postage <br />$ <br />$1.17 I <br /> <br /> Certified Fee $2.70 ff V2 <br />C3 <br />p Return Receipt Fee <br />(Endorsement Required) <br />$2.20 Postmark k <br /> <br />? <br />3 <br />a <br />p Restricted Delivery Fee t <br />N4V 1 J <br />p (Endorsement Required) $0.00 <br />Ln Total Postage & Fees $ $6 <br />07 <br /> . r S? <br />r, Sent To <br />--------------------------------------------------------------- <br />p -• P <br />p eet, A t. No.; <br />r- or PO Box No. <br />City, State, ZIP+4 <br />¦ Complete items 1, 2; and 3. Also complete - Sig ture <br />item 4 if Restricted, is desired. <br />:1 ? Agent <br />¦ Print your name ad address on the reverse' Addressee <br />o. AO <br /> <br />we <br />so that <br />return the card to you. <br />that <br /> <br />¦ Attach this card to the back of the mailpiece, <br />` B. eceived (Printed Name) ate of Deliv ry <br />/ l 7" <br />or <br />the <br />front <br />if space permits. CA <br /> <br />1'. Article AddressedJo: D. Is delivery address different from item ,l.? ? Yes <br /> If YES, enter delivery address below <br />i ` ? No <br />Prowers County <br />ATTN: Board of Commissioners 3. rvice Type <br />301 South Main Street, Suite 215 rtiBed,Mail ? Express Mall <br />Lamar, CO 81052 ([[??? Registered ? Return Recei pt for Merchandise >. <br /> p Qinsured`Mal El C.O.D. <br /> 4 Restricted Delivery? (Extra Fee) ? Yes <br />2. Article Number <br />(rransfer from service label) 7007 <br />25601, H,02 ' 248,6 7051 <br />PS Form 3811., February 2004 ji, ,° rtrR'r?ipt 102595-02-M•1540