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• 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 />I. mmcle Addressed to: <br />Dale and Ellen Schmidt <br />472 Meadows Dr. <br />Pagosa Springs, CO 81147 <br />Pz6rl -0W <br />A. SI nature <br />X ❑ Agent <br />B. Received b Addressee <br />Y (Printed Name) C. ate of Delivery <br />S -Y a7 /Q, <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type <br />❑ Certified Mail <br />❑ Registered <br />❑ Insured Mail <br />❑ Express Mail <br />❑ Return Receipt for Merchandise <br />❑ C.O.D. <br />v. Restricted Delivery? (Extra Fee) <br />2. Article Number E ❑Yes <br />(Transfer from servicefabel) 7009 2820 0003 5700 9831 <br />PS Form 3811, February 2004 <br />Domestic Return Receipt <br />102595 -02 -M -1540 <br />Postal <br />CERTIFIED MAILTf., • • <br />M D• Only; <br />CO <br />Er <br />O <br />f` Postage $ <br />Certified Fee <br />m l <br />1=1 Return Receipt Fee Postmark <br />C3 (Endorsement Required) _ ;f, , Here <br />O Restricted Delivery Fee <br />O (Endorsement Required) <br />Fu 7 i <br />cO Total Postage & Fees ✓ ., �% �—'- - <br />Sent To <br />D" <br />Slreef,ApLIVc Dale and Ellen Schmidt -- °° <br />orPO Box " 472 Meadows Dr. <br />City State, Zlf °_ - -•- <br />•�� Pagosa Springs, CO 81147 <br /> <br />