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5. Received By: (Print Name) <br />Crrc 5s <br />(Addy see or Agent) <br />1 also Wis servi services an <br />services. following a • <br />• • 0 SENDER: <br />1 and/or 2 for additional se n return this extra fee): v , <br />•p ',Complete items and 4b. so that we S Address ' <br />■Co mplete items 3, 4a, does not 1. ❑Addressee' <br />H your name and address on the reverse of this form Address <br />co <br />y • Print y l or on the back if space 2. 0 Restricted Delivery w card to you• to the front of the mail S. . <br />d • Attach this form 1 B Ce below the article d nu bate es t d c ted r for fee. <br />a�i permit. Receipt Requested' o the mai Consult P d <br />`- ■Wree'e Return ce wai show to whom the article was delivered an 296 5 <br />t ■Th Return Receipt 5p15 � . <br />delivered. 1 14 0 p 0 0 4 3 <br />0�8 i <br />3. Article Addresse to: 4b. Service Type CC <br />_ <br />;: <br />( �leflca ❑Reg istered Q Insured w . <br />E U nited State o A <br />grvice i ❑ Ex press Mail COD 7` 0 <br />c U.S. Fores S Receipt Ranger D istrict \, Q Returns Mai 3 <br />W Paonia _ • <br />■ <br />Box 1030 ■ 7 D a te of D e'y =. <br />• o P . _ � ..; a ('0 81428 / G • <br />8. Addressee's Address (Only f requested t <br />and fee is paid) I- <br />Domestic Return Receipt <br />• <br />• c <br />• <br />0 <br />6. Signatur <br />_X <br />PS Form 3811, December 1994 <br />C hOnd (4.W4-CS_Tkop <br />