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SENDER: <br />• Complete items 1 and/or 2 for additional services. <br />• Complete items 3, 4a, and 4b. <br />• Print your name and address on the reverse of this form so that we can retum this <br />card to you. <br />• Attach this form to the front of the mailpiece, or on the back if space does not <br />permit. <br />• Write'Retum Receipt Requested' on the mailpiece below the article number. <br />•The Retum Receipt will show to whom the article was delivered and the date <br />delivered. <br />3. Article Addressed to: <br />Fremont County Commissioners <br />County Commissioner <br />615 Macon Avenue, Room B -5 <br />Canon City, CO 81212 <br />5. Received By: (Print Name) <br />E_ <br />0 6. Signature: (Addressee or Agent) <br />X VC C <br />— PS Form 3811, December 1994 <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 1140 0004 5015 3214 <br />4b. Service Type <br />❑ Registered <br />❑ Express Mail <br />❑ Retum Receipt for Merchandise <br />r' <br />LeAr—t <br />L._l <br />3 dry� <br />❑ Certified <br />❑ Insured <br />❑ COD <br />7. Date of De ivery <br />8. Addressee's Address (Only if requested <br />and fee is paid) <br />Domestic Return Receipt <br />4 <br />