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TC1 Certified Mail Receipts M-2016-002 <br /> u.s. Postal Service'" <br /> CERTIFIED MAILO RECEIPT <br /> r' Domestic Mail Only <br /> C3 <br /> -4 <br /> 0 <br /> P11t.- <br /> C3 �465 <br /> cc <br /> Postage: <br /> $ �Po <br /> C3 R, Certified Fee: $2300 <br /> C3 (Endor <br /> laReturn Receipt Fe <br /> Restri <br /> 0 (Endon �6.465 <br /> ni Total Postage &Fees: <br /> r=I Total <br /> ru <br /> Sent To <br /> Mr. Donald J. Self -------------- <br /> -------------No.,------- <br /> Street&Sent <br /> C3 or 0P 0. Box 473 <br /> or PO Box No. ------------------- <br /> s <br /> 17%- - -------- <br /> 'y'St., Z <br /> Indian Hills. CO 804547 <br /> I SENDER: COMPLETE THIS SECTION r0M.cILETE THIS SECTION ON DELIVERY <br /> • Complete items 1,2,and 3.Also complete ..;Signature <br /> item 4 if Restricted Delivery is desired. X, 0 Agent <br /> • Print your name and address on the reverse A2�a,ta—oAddressee <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. WOR20— I — <br /> D. Is delivery address different from item 1? 1:1 Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: 1:1 No <br /> Mr Donald J. Self <br /> P.O. Box 47') 3. Service Type <br /> Indian Hills, CO 80454 0 Certified Mail® 0 Priority Mail Express- <br /> E3 Registered [3 Return Receipt for Merchandise <br /> [I Insured Mail 0 Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) El Yes <br /> 2. Article Number <br /> (Transfer from service label) ?014 2120 0001 8040 104? <br /> PS Form 3811,July 2013 Domestic Return Receipt <br />