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tit/67/SENDER: COMPLETE THIS SECTION COMPLETE THIS <br /> DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signatur <br /> item 4 if Restricted Delivery is desired. 0 Agent <br /> ■ Print your name and address on the reverse ❑Addressee <br /> so that we can return the card to you. B. Received by(Printed Name) �£ C. Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. <br /> D. Is delivery address different from item 19 es <br /> 1. Article Addressed to: If YES,enter delivery address glow: ❑ No <br /> Mr. L. Otto Goemmer <br /> P 0 Box 165 3. Service Type <br /> La Veta, CO 81055 A Certified Mails ❑Priority Mail Express'" <br /> ❑Registered ❑Return Receipt for Merchandise <br /> ❑ Insured Mail ❑Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number <br /> (Transfer from service label) 7 014 0150 0000 9138 2 3 0 2 _ <br /> PS Form 3811,July 2013 Domestic Return Receipt <br />