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SENDER: <br />v •Complete items 1 and/or 2 for additional services. <br />. m •Complete items 3, 4a, and 4b. <br />H ■ Print your name and address on the reverse of this form so that we can return this <br />L • <br />card to you. <br />d •Attach this form to the front of the mailpiece, or on the back if space does not <br />d permit. <br />■ Write'Return Receipt Requested' on the mailpiece below the article number. <br />.6 •The Return Receipt will show to whom the article was delivered and the date <br />• delivered. <br />.0 3., <br />M <br />E <br />0 <br />N <br />W <br />cc <br />0 <br />G <br />CC <br />W <br />CC <br />0 <br />5. Rectig <br />United State of America <br />BLM <br />2850 Youngfield St. <br />Lakewood, CO 80215 <br />6. S <br />PS Form 3811, December 1994 <br />�l9gy -n�z <br />S L� <br />- i}n-0p `rte+tcaLan <br />�b <br />I also wish to receive the <br />following services (for an <br />extra fee): <br />1. ❑ Addressee's Address E <br />2. ❑ Restricted Delivery <br />Consult postmaster for fee. <br />7007 3020 0001 6340 0126 <br />4b. Service Type d <br />❑ Registered ferCertified rn <br />❑ Express Mail ❑ Insured H <br />❑ Retum Receipt for Merchandise ❑ COD c <br />7. Date of Delivery <br />Zq /'/ T . <br />8. Addressee's dress (Only if requested m <br />and fee is paid) z <br />Domestic Return Receipt <br />