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Certified Mail Receipts <br /> I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3. A. Signature W <br /> ■ Print your name and address on the reverse X ©Elgent <br /> so that we can return the card to you. ressee <br /> ■ Attach this card to the back of the mailpiece, B. Recelve by(Printed arr)e) t� C. Date of Pellvery <br /> or on the front if space permits. <br /> 1 Article Addressed to: D. Is delivery address different from item 1? ❑Yes <br /> If YES,enter delivery aoclr4s uelow. ❑No <br /> Jacque Goemmer <br /> L.Otto Goemmer <br /> P.O.Box 165 <br /> __La Veta,CO 81055 <br /> I <br /> 3. Service Type ^Pncr,y Mat Enpres$O <br /> C moult Siyoaturm _,hegisteeo MWI!, <br /> ❑Adult Signature Restricted Delivery u Registered Mad Restncied <br /> ❑Certified Mail® Delivery <br /> •Certified Mail Restricted Delivery ❑Retum Receipt for <br /> ❑Collect on Delivery Merchandise <br /> nrti�io ni„mho.?ranefnr fmm mniiro rat an ❑Collect on Delivery Restricted Delivery 0 Signature Confirmation"'" <br /> ail 0 Signature Confirmation <br /> 7 014 2120 0001 7885 3445 ail Restricted Delivery <br /> Restricted Delivery <br /> t) <br /> PS Form 3811 July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> Postal <br /> ■ . • <br /> u'1 <br /> Domestic Mail Only <br /> m For deli very information,visit our website at wwwusps.corn�. <br /> r, _ <br /> co Postage: <br /> `° Certified Fee: $4 460 <br /> r` �"/ AJ50 <br /> a Return Receipt Fee: t f : <br /> E3 $ .750 <br /> Rea <br /> o (E11orse Total Postage and Fees:.' <br /> Resmcte.. ..._., $6.56 <br /> p (Endorsement Required) <br /> ru <br /> rq Total Postage&Fees <br /> ru <br /> -r SentTo Jacque Goemmer <br /> ra - L.Otto Goemmer <br /> ED $vest S Apt.Ao P.O.Box 165 <br /> r` or PO Bar No. La Veta,CO 81055 <br /> City State:ZIP+4 -------- ------------------- <br /> PS Form :0r July 2014 <br />