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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 />Mr. Nick M. Brinkman <br />1 stBank Avon <br />P O Box 5270 <br />Avon, CO 81620 <br />A. <br />❑ Agent <br />❑ Addressee <br />C. Date of Delivery <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type <br />56ertified Mall ❑ Express Mall <br />❑ Registered ❑ Retum Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7010 1060 0001 0936 5753 <br />(transfer from service /abeq <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />giomestic Mail c <br />for delivery ir�for►n; <br />J <br />117 <br />Postage: j` <br />$0.69 <br />° <br />Certified Fee: <br />$3.�i0 <br />Reh. Return Receipt Fee: 4 <br />$2. 0 <br />C3 <br />0 <br />(Endorsee <br />Restnctc <br />(Endorse; Total Postage & Fees: <br />$6.69 <br />O <br />Total Postage & Fees I $ <br />r� <br />C3 <br />sent To Mr. Nick M. Brinkman <br />a <br />O <br />Street. Apt No.. <br />- --- ----- --- --- - - -- 1 stBank Avon <br />------ - - - - -- <br />or PO Box No <br />Grystete.ZlP +4 P O Box 5270 --------------- <br />--- - -- <br />Avon, CO 81620 <br />