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d SENDER: <br />:o ■ Complete items 1 and/or 2 for additional services. <br />w •Complete items 3, 4a, and 4b. <br />H <br />■ Print your name and address on the reverse of this form so that we can return this <br />L. card to you. <br />d ■ Attach this form to the front of the mailpiece, or on the back if space does not <br />E permit. <br />■ Write'Retum Receipt Requested' on the mailpiece below the article number. <br />• M •The Return Receipt will show to whom the article was delivered and the date <br />c delivered. <br />. ° 'f A.+:.d.' A h 1r o' Oft tn. <br />Douglass E. Kiesau <br />P. O. Box 771964 <br />Steamboat Springs. CO 80477 -1964 <br />• 5. Recei <br />cc Yc <br />0 <br />0 <br />6. Sig <br />X <br />Ind By: (Print Name) <br />. C i t j e CGc' <br />re: ; S: • ressee or went) <br />PS Form 3tf11 December 199 <br />I also wish to receive the <br />following services (for an <br />extra fee): <br />1. ❑ Addressee's Address <br />2. ❑ Restricted Delivery <br />Consult postmaster for fee. <br />7008 3230 0002 7252 5462 <br />4b. Service Type <br />❑ Registered (7214-Certified <br />❑ Express Mail ❑ Insured <br />❑ Return Receipt for Merchandise ❑ COD <br />7. Date o 2_21 1/ <br />8. Addressee' Address (Only if requested <br />and fee is paid) <br />Domestic Return Receipt <br />1 <br />