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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 />1. Article Addressed to: <br />A. Signature <br />X 13 Agent <br />O Addressee <br />B. Received by (Printed Name) I C. Date of Delivery <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />,Joe Thomeczek <br />Bent County Ready Mix <br />P.O. Box 387 3. <br />Las Animas, CO 81054 Q CAc Mail 13 Express Mall <br />❑ Registered ❑ Retum Receipt for Merchandise <br />❑ Insured Mali 0 C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number <br />(Transfer from service label) ?011 3500 0 0 0 2 9605 5 3 8 9 <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540, <br />