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m A4 ttrigd <br />1. Article Addressed to: <br />// Abu, 1 -d & <br />U.S. Postal Service,. <br />CERTIFIED MAILTM RECEIPT <br />(Domestic Mail Only; No Insurance Coverage Provided) <br />For delivery information visit our website at www.usps.come <br />Postage: <br />Certified Fee: <br />Retum Return Receipt Fee: <br />(Endorseme <br />Restricted Total Postage & Fees: <br />(Endorseme <br />Total Postage & Fees <br />Sent? Ernie Ward <br />Street Colorado Community Bank <br />or PO <br />C;ry, 102 N. Washington <br />Otis „CO 80743 <br />SENDER: COMPLETE THIS SECTION <br />• Complete items 1, 2, and 3YAIso 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 maiipiece, <br />or on the front If space permits. <br />Ernie Ward <br />Colorado Community Bank <br />102 N. Washington <br />Otis, CO 80743 <br />A. Signature <br />3. Service Type <br />❑ Certified Mall <br />❑ Registered <br />❑ Insured Mail <br />$0.45 <br />$2.95 <br />=2.35 <br />4 <br />$5.75 <br />COMPLETE THIS SECTION ON DELIVERY <br />B. Received by (Printed e) <br />� eR <br />D. Is delivery address d <br />If YES, tinter delive <br />fro itR�ern 1? <br />ress b eRSV <br />❑ Agent <br />❑ Addressee <br />V. of Delivery <br />0+ <br />❑ Express Mall <br />❑ Return Receipt for Merchandise <br />❑ C.C.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number <br />(Transfer fromservlcelabel) 7011 3500 0002 9607 8562 <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -Q2 -M -1540 <br />H <br />