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2009-11-24_REVISION - C1981042
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2009-11-24_REVISION - C1981042
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Entry Properties
Last modified
8/24/2016 3:57:13 PM
Creation date
11/24/2009 10:07:51 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981042
IBM Index Class Name
REVISION
Doc Date
11/24/2009
Doc Name
Certified Mail Receipt (Termination of Jurisdiction)
To
Landowners
Type & Sequence
SL1
Email Name
TAK
Media Type
D
Archive
No
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�u.Y -* <br />E3 Postage: $2.80 <br />° Certified Fee: $2,30 <br />C3 (I- Return Receipt Fee: <br />Er F <br />M (Ei Total Postage & Fees: $5.54 <br />0 <br />Tom Postage & Fees <br />Ln <br />C3 Sen <br />Michael G. Rosenberg --------- - - - - -- <br />orF 1982 CR 122 --------- - - - - -- <br />chy Hesperus, Co 81326 <br />• 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 />Michael G. Rosenberg <br />1982 C R 122 <br />Hesperus, Co 81326 <br />4. Restricted Delivery? (Extra Fee) <br />❑ Yes <br />2. Article Number 7005 0390 0002 8281 9240 <br />(transfer from service label) <br />PS Form 3811, February 2004 Domestic Return Receipt 102595- 02 -W1540 <br />A. Signature <br />13 Agent <br />X <br />1t Addressee <br />F{ ive, by Prf Name) � <br />h�, 6se� <br />C! bate of Delivery <br />D. Is delivery address different from ftwif 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type <br />❑ certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Recelpt for Merdmdise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) <br />❑ Yes <br />2. Article Number 7005 0390 0002 8281 9240 <br />(transfer from service label) <br />PS Form 3811, February 2004 Domestic Return Receipt 102595- 02 -W1540 <br />
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