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2012-05-11_REVISION - C1981038 (2)
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2012-05-11_REVISION - C1981038 (2)
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Entry Properties
Last modified
8/24/2016 4:57:33 PM
Creation date
5/14/2012 9:35:23 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981038
IBM Index Class Name
REVISION
Doc Date
5/11/2012
Doc Name
Certified Return Receipt (Inspection Notification)
From
Martin Pavlisick and Jennie Pavlisick
To
DRMS
Type & Sequence
SL4
Email Name
BFB
SB1
Media Type
D
Archive
No
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NuitcorLikon <br />SENDER: COMPLETE THIS SECTION <br />COMPLETE THIS SECTION ON DELIVERY <br />D. <br />gent <br />Addressee <br />• 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 />1. Article Addressed to: <br />Martin J. Pavlisick and Jennie Pavlisick <br />C/o Kenneth J. Pavlisick <br />1460 41b8 Lane <br />Paonia, CO 81428 <br />2. Article Number <br />(Transfer from service label) <br />PS Form 3811, February 2004 <br />Is delivery address different from item 1? ❑ <br />If YES, enter delivery address below: <br />3. Service Type <br />❑ Certified Mail <br />❑ Registered <br />❑ Insured Mail <br />Domestic Retum Receipt <br />4. Restricted Delivery? (Extra Fee) <br />7008 3230 0002 7252 9408 <br />REGENEt <br />MAY 11 20 <br />Uivisloi� U d Sa efi! n, <br />Mining <br />C. Date of Qelii ery <br />Yes <br />❑ Express Mail <br />❑ Retum Receipt for Merchandise <br />❑ C.O.D. <br />❑ Yes <br />102595 -02 -M -1540 <br />
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