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I <br /> SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS . . <br /> ■ Complete items 1,2,and 3. A. Signature <br /> ■ Print your name and address on the reverse X ❑Agent <br /> so that we can return the card to you. _ __ ❑Addressee_ <br /> ■ Attach this card to the back of the mailpiece, Received by(Piloted Name) I C. Date of Delivery <br /> or on the front if space permits. <br /> 1 Article Addressed to: D. Is delivery address different from Item 1? ❑Yes <br /> Ms. Marcy Brossman It YES.inter dali�ery address belovv. ❑ No <br /> Cheyenne County <br /> 51 S. 1st. <br /> P.O. Box 567 <br /> Cheyenne Wells, CO 80810 <br /> II I II�I�I I II ')I II I III'I I II III II�I I II I I I I I El Adult Sig eg nature Restricted Delivery ❑Registered Mail Restricted <br /> ❑Certified Ma& Delivery <br /> 9590 9402 2053 6132 7812 24 ❑Certified Mal Restricted Delivery L1 Return Receipt for <br /> _ ____ ❑Collect on Delivery Merchandise <br /> 2 Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation'" <br /> C insured Mal ❑Signature Confirmation <br /> 7 01(0 0-1 L/D 0000 0�-3 Ifl. ��J?J� t I Insured Mal Restricted Delivery Restricted Delivery <br /> (river$500) <br /> PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> Postal <br /> CERTIFIED ■ a <br /> Er m I. <br /> For delivery information,visit our wei;isite at tvww.usps.com,1. <br /> m Postage: PAl 70 <br /> nu Certified Fee: 3.350 <br /> o Return Receipt Fee: $2, <br /> C3 �91 <br /> „ark <br /> C3 �. <br /> Total Postage & Fees. rp 6.770 <br /> p Postage .i1- <br /> $ f Q,,,. <br /> NTotal Postage and Fees Ms. Marcy rossman <br /> $ Cheyenne County <br /> -U Sent ro <br /> r-3 51 S. 1st. <br /> 0 S`freet andApt 7�To.,or W$ox ffk <br /> - P.O.Box 567 <br /> Cheyenne Wells, CO 80810 <br /> PS Form 3800,April 2015 , 1I,•, <br />