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Certified Mail Receipts <br /> COMPLETE •N COMPLETE THIS SECTIO ON DELIVERY <br /> ■ Complete items 1,2,and 3. iBlRecerv <br /> Signature <br /> ■ Print your name and address on the reverse !3 ptgent <br /> so that we can return the card to you. ressee <br /> ■ Attach this card to the back of the mailpiece, by(Printed arrSe) �7C. 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 /> It YES,enter delivery atldr4S below ❑No <br /> Jacque Goemmer <br /> L Otto Goemmer <br /> P.O.Box 165 <br /> La Veta,CO 81055 <br /> 3. Service Type C Fr,cr y Ma,ErpreSSO <br /> C Adult Sigi.atur. ,-negistered load" <br /> D Aouft Signature Restricted Delnery ❑Registered Mail Restricted <br /> ❑Certified Mail® Delivery <br /> ❑Certified Mad Restricted Delivery ❑Return Receipt for <br /> ❑Collect on Delfvery Merchandise <br /> o Arhirlu nl,,.tio.(T ancfur frn.n ccrvira rar on ❑Collect on Delivery Restricted Delivery El Signature ConfirmationTM <br /> ❑Signature Confirmation <br /> 7 014 2120 0001 7885 3445 ,d Restncted Delivery Restricted Delivery <br /> PS Form 3811 July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> Postal <br /> PRECEIPT <br /> u'1 <br /> Domestic Mail Only <br /> m I- For delivery information,visit our website at wwwxspsxorni�. <br /> C " Postage: $Q 460 <br /> ca Certified,Fee: <br /> $1x350 <br /> r� Return Receipt Fee:, �'$?.750 <br /> Rs <br /> C3 (Endorse <br /> Total Postage and Fee":" $6.56 <br /> Restricts. . ..._., <br /> Q (Endorsement Required) <br /> ru <br /> r1(J Total Postage 8 Fees $ <br /> = Sent To Jacque Goemmer <br /> L Otto Goemmer •------------------------------- <br /> C3 Street&Xf f.RId., P.O.Box 165 <br /> r - or PO Box No. La Veta,CO 81055 <br /> -----------------• •------------------------------ <br /> 04t State,ZIPt4 <br /> PS Form :00 July 2014 <br />