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el <br />ce-r,�,f,�e I <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 />Phillips County <br />Randy Schafer <br />221 S. Interocean Ave <br />Holyoke, CO 80734 <br />A. Signature <br />X <br />/� �'/ I <br />.� ` <br />❑Addressee <br />Received <br />(Printed Na ) <br />C. Date of Del' v ry <br />—I <br />I - <br />D. Is delive <br />address different from item 1? <br />❑ Yesl <br />If YES, enter delivery address below: <br />❑ No <br />3. Se ice Type <br />zertlfied Mail ❑ Express Mall <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article asferuom 7011 3500 0002 9607 6568 <br />(I- ransfer from service fabeQ _ <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />.moo ' ' ' - <br />Ln <br />$1.40 <br />postage: $3.30 <br />°" Certified Fee: $2.70 <br />t Fee ��" � -�- ',. <br />ru Return Receip : r " <br />. $ 0 ark <br />C3 <br />I3 (t <br />C3 Jotal postage & Fe <br />C3 (E ... -ument Required) <br />C3 j <br />Ln Total Postage & Fees $ <br />M <br />r-1 Sent To Phillips County <br />C3 p Randy Schafer ------ - - - - -- <br />� Street, A t No.; <br />�- or PO Box No. <br />-C- ity SBoxN 221 S. Interocean Ave- ------ - - - - -- <br />:,, . Holyoke, co 80734 <br />