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m SENDER: <br />. •Complete items 1 and/or 2 for additional services. <br />in •Complete items 3, 4a, and 4b. <br />92 • Print your name and address on the reverse of this form so that we can return this <br />41.) • Attach this forrn to the <br />card to you. ,___, of the ,,,;;, weS. or on the back if space does not <br />permit <br />■Wnte Retum Receipt Requested' on the mailpiece below the article number. <br />L ■The Return Receipt will show to whom the article was delivered and the date <br />c delivered. <br />0 <br />3. Article Addressed to: <br />B <br />d <br />0. <br />0 <br />V <br />cc <br />0 <br />C) <br />William E. Bray <br />P 0 65 <br />Redvale, Colorado 81431 <br />Ps Form 3811, December 1 •4 <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 5363 <br />4b. Service Type <br />❑ Registered <br />❑ Express Mail <br />❑ Return Receipt for Merchandise ❑ COD <br />7. Date of Delivery <br />C__,V 1- M <br />SL 3 <br />�v\ovCQ.Lon <br />NA*Qa <br />❑ Certified <br />❑ Insured <br />8. Addressee's Address (Only if requested <br />and fee is paid) <br />u <br />N <br />Domestic Return Receipt <br />C) <br />RECEIVIIiD <br />APR 2 6 2012 <br />Division or medarnation, <br />Mining and Safety <br />