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14IM103 <br /> U <br /> SENDER: COMPLETE THIS SECTION . DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Si u <br /> item 4 if Restricted Delivery is desired. ❑Agent <br /> ■ Print your name and address on the reverseF77 ❑Addressee <br /> so that we can return the card to you. B. Received b (Prin � m ae) C. Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, c (gl Zs�l <br /> or on the front if space permits. <br /> D. Is delivery address different from Rem 1? ❑Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑No <br /> Mr.Matthew Valdez <br /> Costilla County l 7C �Gl� <br /> PO Box 130 <br /> ws,CO 81152 Ll <br /> 3. ice Type <br /> ES Certified Mail ❑Express Mail <br /> ❑Registered ❑Return Receipt for Merchandise <br /> ❑Insured Mall ❑C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number(Transfer from service label 7 011 3500 0002 9 6 0 7 7 619 <br /> __--- -_-- - - -- - <br /> Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 <br />