HomeMy WebLinkAbout20010861.tiff RESOLUTION
RE: APPROVAL OF RENEWAL REQUEST FOR 3.2% BEER LICENSE ISSUED TO MRS.
LEO K. WARDMAN, DBA LEO'S HUT - EXPIRES JULY 18, 2002
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, Mrs. Leo K. Wardman, dba Leo's Hut, presented to the Board of County
Commissioners of Weld County, Colorado, an application for the renewal of a County Retail
License for the sale of fermented malt beverages, containing not more than 3.2% of alcohol by
weight, and
WHEREAS, pursuant to Exhibit 5-H of the Weld County Code, said applicant has paid
the sum of$57.50 to the County of Weld for the renewal of the existing license, and
WHEREAS, said applicant has exhibited a State License for the sale of 3.2% fermented
malt beverages in sealed containers not for consumption at the place where sold, outside the
corporate limits of any town or city in the County of Weld at the location described as follows:
Route 66, Highway 85, Carr, Colorado 80612
NOW, THEREFORE, BE IT RESOLVED that the Board of County Commissioners of
Weld County, Colorado, having examined said application and the other qualifications of the
applicant, does hereby grant License Number 2001-04 to said applicant to sell 3.2% fermented
malt beverages in sealed containers not for consumption at the place where sold, only at retail
at said location; and the Board does hereby authorize and direct the issuance of said license by
the Chair of the Board of County Commissioners, attested to by the Clerk to the Board of Weld
County, Colorado, which license shall be in effect until July 18, 2002, providing that said place
where the licensee is authorized to sell 3.2% fermented malt beverages in sealed containers
not for consumption at the place where sold, shall be conducted in strict conformity to all of the
laws of the State of Colorado and the rules and regulations relating thereto, heretofore passed
by the Board of County Commissioners of Weld County, Colorado, and any violations thereof
shall be cause for revocation of the license.
2001-0861
LC0018A
fre.' App/, SO
RENEW 3.2% BEER LICENSE - LEO'S HUT
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 16th day of April, A.D., 2001.
BOARD OF COUNTY COMMISSIONERS
WEJ.,Q COUN COLORADO
J
ATTEST: {JL _ / „i •
Ley• �• ( ,; at J. Geile, Ch 'r
Weld County Clerk to the =
' pp "� tlenn Vaad, Pro-
BY: hL I'��. J At
Deputy Clerk to the Board C�� ice, �m
Wil a H. Jerre
'PRO') AS TO�
�� David;,. ong
A orney
Robert D. Masden
2001-0861
LC0018A
ONLY 3 .2 % BEER SOLD HERE
} /Y y1,f r , A ')a f4, ti t r i1 �v ;r
��I•`+ ��\ '.•l/i � '\N � �N�� '`\1.�� t � `.�" \`\ M'nu p �` �;li�i ,,4flY`\y i.- ii,".,t.a� �y�e !!it JS :S IM') i� !�/" !St„i 1� �/Nef6. `1 1\/fit;M� ` . { /i/'
'e, .\ .. e:-?!! _. ?,\g.t, :�a / \,n,. .2f/ -.l�l\a�� \ :r4/ '-„ , . :'lim •₹0.:4. —;.ti <'al3i r.'+\\a'.::t6.t 0,, "S\\4;xh.-. i/fs..:i'�flh. h:rA//l;:'n e aii p i\v ,i
i `siOwt a/ ,,.,;43
,,*i.- 1 Akw �.. �&. �,q/"f,,tt x•40,e- x1:';71.: (*A ,* -- - ,-,:t .«5 yilflgll�\.fls_. w,.4,if{6s/"i/i \a451,14b,(411-,fl }%Si'e F\«Mato* ,, \��__. g.. fL. , (
.e ;4 dpi '?'/"...-'/ / ';\ffl .:2,0,,,A
tit...
9 ,+d b �' -'w`i fl w �Nz < w .. r "3n s -4•a 1), " r ,s� E.zIa,
s,, si.i CV,}d i�t` t. ` 1 r rr4 '� P�;, rF r ,�r r e wf -,�kav ry ',� r '
�.TI L ' 1, 6 .-. _ `� ` \c'-V111-17.1p.2 ,rI
�, y STATE OF ... o oa: „ COLORADO ..- ' .'m r'/!3 ₹4.' �'
.E•�' `�� t COUNTY OF WELD (4 • ":,;:is,C
e 3{� r_ � BY AUTHORITY OF THE BOARD OF COUNTY COMMISSIONERS tl
f , Fermented Malt Beverage License I
fx�fc RETAIL : ® , � .
w; - r \
alilis is to fdtrtifg, That. Mat LeQ._K. _Waramn>_—Oa_LeQ'.s..tlut---•---_---_.._.....__..__.__.__._.._---• i
k -„,.1 of the State of Colorado, having applied for a License to sell FERMENTED MALT BEVERAGES at retail and having a `'.�
` paistid •to the Treasurer of Weld County, the sum of Fifty-seven and 50/100 Dollars therefor, the above applicant is = "
,r hereby licensed to sell FERMENTED MALT BEVERAGES containing not more than 3.2% of Alcohol by weight at 7
s
. Pr RAVSe__66_,__ V ghwzs___$5,___car .,__.Colo a.do__EM12 ti(, i
�,_ ,{ in the County of Weld, Colorado, for one year from the 19th day of July 2001 - `
18th Jul 2002
to the day of y unless this License be sooner revoked
as provided by law. -
,! This License is issued subject to the Laws of the State of Colorado, and especially under the pro- , !)
visions of Article 46 of Title 12, Colorado Revised Statutes, as amended. Nt ,
,: IN TESTIMONY WHEREOF, The Board of County Commissioners has hereunto subscribed its , -a- 6
6 name b its officers d ly authorized,thisday of April , 2001,�, _ \,
�e
w ,. .. - _�'C L�' M�:Ft- 1 16th axs?\x ae. 'fie aravaG 3x 1�' tv.\in 'c a�` ,�.J^ �R rat.-�� e' .;
fit'
y I.c-F.,
�. _ ae . .f;.. .. t.`. "� t J ♦ w.ae w tyr,m ° a4Ym:# FW',4 *-fiv- 0:Fii -' .r- t - - Rq x$ . . 4'44/.. n ;rry t a k. 'S-�-,p=r".X. e cx c. k g..s. it
x «'$`" a d t .x ,& /� . 1 11t `,� y+tt,: d sf" '� - a...4.f"a' . .isd•s ' a
! "4 :1:1: ' f •P-. . i' e/t e3 .`xt s s s &tkF f
'►;LC .b,> 3 ^�.m -y+.F-c. {^5s a.F.--s s •e.+a c �.k 3.j.#.k; $r / s �S �'7-I+ .t -- --'�°3 i _�� e �, i 4
A I: �. '� ® •'u' �'. f ,.;i It •® _ ;� . .+
` li js�+i .ice 1 1. / , -.� , t ..k R ra`
t "H`\i/!Y' �.2`+4\flC%/I^rj•� . ti A %!� V\i�%/ VVI'0%� ��� fl y�
V IM i v a� [,/ L� ♦•. illy et ° rlxi D rev x/�L f. . ♦fl� /l/, N°�A! 9/I// 1 vAV , a
\fl\. ,,//, 5 I,li !] \\ l,/I \;\�\ ,0 ✓ \fl\E;-,/il 'n // fl ! \ i, \\ i
\\:eii /Ii Y :x ': ail,:
r \N -.../l, \\.: iI „ is\\ /fif ) \< if s \s\ il/ �' \s /! ,, .,.i,i \\\ i/// ),,ti).).:%..);',r,:), '\
,:: ° :^e , - 1 �,i y , i
III _
THIS LICENSE MUST BE POSTED IN PUBLIC VIEW
DR 8402(02/991
STATE OF COLORADO
DEPARTMENT OF REVENUE
Liquor Enforcement Division
1375 Sherman Street
Denver,Colorado 80261
WARDMAN LEO K MRS
LEOS HUT
RT 66 HWY 85
CARR CO 80612
ALCOHOL BEVERAGE LICENSE
Liability Information
Account Number County City Indust. Type Liability Date LICENSE EXPIRES AT MIDNIGHT
14-09594-0000 03 020 005921 I 071970 JUL 18, 2002
Type Name and Description of License Fee
2122 3.2 PERCENT BEER RETAIL $ 50.00
LICENSE (OFF PREMISES)
2190 COUNTY 85 PERCENT OAP FEE $ 42.50
TOTAL FEEISI $ 92.50
This license is issued subject to the laws of the State of Colorado and especially under the •
provision of Title 12, Articles 46 or 47, CRS 1973, as amended. This license is
nontransferable and shall be conspicuously posted in the place above described.This license is
only valid through the expiration date shown above. Questions concerning this license should
be addressed to the Department of Revenue, Liquor Enforcement Division, 1375 Sherman
Street,Denver,CO 80261.
In testimony whereof,I have hereunto set my hand.
�. LM Pz4
APR 2 4 2001
Division Director
Executive Director
DR aaoo IovoD License Number License Type
COLORADO DEPT OF REVENUE LIQUOR OR 3.2 BEER LICENSE 14-09594-0000 2122
73075 RERFORCEEMENT DIVISION RENEWAL APPLICATION Liability Information
DENVER CO 80281 03 020 005921 I 071970
Business Location
RT 66 HWY 85
WARDMAN LEO K MRS CARR CO
LEOS HUT
Current License Expires JUL 18, 2001
CARR CO 80612
YE This renewal reflects no changes from the last Wholesaler, manufacturer, importer, and public transportation
application.Complete page 2 and file now! system license renewals do not need Local Licensing Authority.
❑ Yes there are changes from the last application. approval and must be returned directly to the Colorado
If applicant is a Corporation or Limited Liability Department of Revenue at least 30 days prior to the current
company, use DR 8177 and send in with this license expiration date.
renewal. Any other changes of ownership require a
transfer of ownership. See your Local Licensing
Authority immediately. This application for renewal must be returned to your CITY
❑ Delivery Permit requested?Retail Liquor Store,Drug OR COUNTY Licensing Authority at least 45 days-prior to ifte
Store or 3.2%Beer-Combination On/Off Premises expiration date of yotr current license.Failure to do so may
Licenses ONLY. Check the box if you want the result in your license not being renewed Include both pages
permit to be issued of this renewal and payment
................................. .. >AP
.. .........................................
:;:»:.::»»;::::>;;>:>;::::::»>;>:<:::::::::;»;:;: TTI OF....F'LNT 5 i:>i i i≥≥: > i i:i:i:isi':i::::: :!asi::::i:::::::::i:i::::i:i :::<:i>.
I declare under penalty of perjury in the second degree that this application and all attachments are true,correct, and complete to the
best of my knowledge.
Authorized Signature Date I Business Phone
;2,z4 p _' Wa_Ati a.✓ c3-rV.q- oo! V-770-;97-2323
Title of Signer(if corporation) Sales Tax Number
/9-0 9 4-9 4/ - Co.. ew .
3 :::::::?> :2
:;1' ? H: REPORT:A ND:APPROVAL:OFC OR:COONTY.taCgNSING:AVE 1 '?> ® ..
IT
The foregoing application has been examined and the premises, business conducted and character of the applicant art \\-L' IL,..hereby report that such license, if granted, will comply with the provisions of Title 12, Articles 46 and 47, - • '•,•—
APPLICATION IS APPROVED.
I Fork ..��
in
Local Licensing Authority for ] ;lel• '
Weld County, Colorado ❑ Town/City Q] County I t I ,�r.t'
Signets e, Title , �-d-, r t
5, 7.7 Chair, Weld County Attest �l,{1� fir
�/// $LCu Board of Commissioners �[ _ rA1 *fr /
pp �"ri •
DO NOT DETACH DO NOT DETACH - + �,'_rillRAVI
DR 8400 (01/01) 21
COLORADO DEPT OF REVENUE LIQUOR OR 3.2 BEER LICENSE
1375 SHERMAN ST RENEWAL APPLICATION
DENVER CO 80281
Business Name LICENSE NUMBER(Use for all reference) RENEWED LICENSE EXPIRES AFTER
LEOS HUT 14-09594-0000 07- 18-02
TYPE OF LICENSE ISSUED CASH FUND STATE FEE
3.2 PERCENT BEER RETAIL COUNTY 85% OAP
LICENSE (OFF PREMISES) 2330- 100 ( 999) 2122-750 ( 999 ) 2190- 100( 999)
$ 25 . 00 $ 25. 00 $ 42 .50
TOTAL AMOUNT DUE $ 92 . 50
•
2001-0861
Make check payable to:Colorado Department of Revenue i_`i oo i -A
DR 8401 (0797)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1881 PIERCE ATTACHMENT TO LIQUOR OR
LAKEWOOD,CO 80261
(303)205-2300 3.2 BEER LICENSE RENEWAL APPLICATION
This page must be completed and attached to your signed renewal application form.
Failure to include this page with the application may result in your license not being renewed.
Trade Name of Establishment State License Number
LEO 'S Hu -o 9.3-95,-0006
1.Operating Manager Home Address Date of Birth
& o// Pc - e-/V' / - /
2. Do you have legal possession of the premises for which this application fo license is made? Yes No
Are the premises owned or rented: &Y.-or,_gae If rented,expiration date of lease:
3, Has there been any change in financial interest(new notes,loans,owners,etc.)since the last annual application?If yes,explain in Yes No
detail and attach a listing of all liquor businesses in which these new lenders or owners,(other than licensed financial institutions)are
materially interested.
4. Since the date of filingofthe last annual application,has the applicant,or any of its agents,owners,managers,principals,or lenders Yes No
(other than licensed financial institutions),been convicted of a crime?If yes,attach a detailed explanation.
5. Since the date of filing of the last annual application,has the applicant,or any of its agents,owners,managers,principals,or lenders
(other than licensed financial institutions),been denied an alcoholic beverage license,had an alcoholic beverage license suspended or Yes No
revoked,or had interest in any entity that had an alcoholic beverage license denied,suspended or revoked?If yes,attach a detailed ❑
explanation.
6. Does the applicant,or any of its agents,owners,managers,principals,or lenders(other than licensed financial institutions),have a Yes No
direct or indirect interest in any other Colorado liquor license(include loans to or from any licensee,or interest in a loan to any ❑
licensee)?If yes,attach a detailed explanation.
7. Sole owners or husband-wife partnerships answer this question.Since the date of filing of the last annual license application:
Has ownership changed in whole or in part,from a sole owner to any other person,partnership,corporation,or limited liability Yes No
company other than the licensee listed on your state liquor license?If yes,this license must be transferred to the new owner and n (
may not be renewed.Contact your Local Authority immediately.
8. Partnership applicants must answer this question.Since the date of filing of the last annual license application: Yes No
(a) Are there,or have there been any general partners added to,or deleted from the partnership?If yes,this license must be
transferred to the new partnership and may not be renewed.Contact your Local Authority immediately.
(b) Are there,or have there been any limited partners with a 10%or more interest,added or deleted from the partnership?If yes,this I-I ❑
license must be transferred to the new partnership and may not be renewed.Contact your Local Authority immediately. I_
9. Corporate applicants must answer this question.Since the date of filing of the last annual license application: Yes No
(a) Are there,or have there been any officers or directors added to,or deleted from the corporation?If yes,complete and attach
DR 8177 and submit to your Local Authority immediately.
(b) Are there,or have there been any stockholders with 10%or more of the issued stock,added to,or deleted from the corporation?
If yes,complete and attach DR 8177 and submit to your Local Authority immediately. ❑ ❑
(c) Date of filing last annual corporate report with the Colorado Secretary of State:
10. Limited Liability Company applicants must answer this question.Since the date of filing of the last annual license application: Yes No
(a) Are there,or have there been any managing members added to,or deleted from the company?If yes,complete and attach
DR 8177 and submit to your Local Authority immediately. ❑
(b) Are there,or have there been any members with 10%or more membership interest,added to,or deleted from the company?
If yes,complete and attach DR 8177 and submit to your Local Authority immediately. ❑
(c) Date of filing last annual LLCO report with the Colorado Secretary of State:
11. Bed and Breakfast applicants must answer this question and certify compliance with 12-47-118.5 C.R.S.,to the state licensing
authority by initialing the following listed questions:
That it has no more than 20 sleeping rooms,and
That it provides at least t meal per day at no charge other than for overnight lodging,and
That it does not sell alcoholic beverages by the drink or in sealed containers,and
That it shall not serve alcoholic beverages for more than 4 hours in any one day,as follows:
MONDAY HOURS TUESDAY HOURS WEDNESDAY HOURS THURSDAY HOURS FRIDAY HOURS SATURDAY HOURS SUNDAY HOURS
From: m. From: m. From: m. From: m. From: m. From: m. From: m.
To: m. To: m. To: m. To: m. To: m. To: m. To: m.
LIQUOR/BEER RENEWAL REVIEW FORM
Date: March 29, 2001
TO: Deputy Harbert
FROM: Kim Fliethman
SUBJECT: Liquor License Check
In accordance with the new procedure for Liquor and/or beer license checks, please review all
records on the following establishment for any associated reports during the last year and
return your report to the Weld County Clerk to the Board's Office within two weeks. Your
report will be used by the Board of County Commissioners in considering renewal of the liquor
and/or beer license.
PLEASE RESPOND NO LATER THAN: APRIL 12, 2001
ESTABLISHMENT: MRS. LEO K. WARDMAN
DBA LEO'S HUT
ROUTE 66, HIGHWAY 85
CARR, CO 80612
Current license expires: JULY 18, 2001
........ ..................................................................................................
! No concerns t/ ii
Deputy's Initials
The Sheriffs Office had a concern and the deputy has mutually
worked with the licensee to correct the concern.
(Complete Attached Worksheet)
Unresolved concerns exist requiring a Probable Cause Hearing
scheduled by the Board of County Commissioners.
(Complete Attached Worksheet)
............................................................................................................
Please notify at Extension of the date and time of the
Board of Commissioner's renewal hearing.
X99? o /-A0 e nu; J5 or co, cc,
u1d7 7 dui r
/ \ MEMORANDUM
// t To: Esther Gesick, De uClClerk to the Board March 29, 2001
From: Bethany Salzman,Zoning Compliance Officer, Dept. of Planning Serviceswok
COLORADO Subject: LC0018-A
Review of the following liquor license renewal by the Department of Planning Services shows the following:
14-09594-0000
Mrs. Leo K. Wardman
dba Leo's Hut
Route 66, Highway 85
Carr, CO 80612
Zone District: Agricultural
This use is allowed through a Nonconforming Use (NCU-0027)for a Restaurant/Tavern and the sale of 3.2 beer.
No violations are occurring on the property at this time.
SERVICE,TEAMWORK,INTEGRITY,QUALITY
x.51 Es r.> e 1, �
4
J:,y y di--14:64,'4
a•
tL.k:/aF� ��i t`.1 ��s
FeeEa 8121 6400 7642 .-.:,,,,-3„,,,,,,..1,,,,,„.„-:-„;-,,,,-_,,..,,,,,,,t,:�
F� xix,. USA Ali rbill rrarainp �� t3 ,5 .
1 Numoer 10 N +� .
1 From Pre..prat end press h„d 4a Express Package Service Packages eprof5albx
//'' !!���,�Fy Senders FedEx Dee ery tom m may b.Wel$n rro area.
Date 7—e �`vl�� Account Number 1253-1948-3 ❑FedEx PriontyOvernight ❑FedExStandardOvemight dfxRrstOvernight
Nee business mormne Neehu;nea enemran retest nevi husness mNlMe
/� 1 fj� ,/) �j �/�,�,� ��ry ] Seamryto select locations
Name Sender's
f k /O i/Jf= i1 f Cf Phone 7 7 )1.56-7iwr•'x 00151714, �n y" ❑ pr
(� ( � T fedEx 2Da FedEx Express Saver'
o dbusiness day third Maness day •Fedh 0h 090 naaonlr0e
Minrimn cluree:Oneaa,urd rw
Company COUNTY OF WELD 4b Express Freight Service acrragluasonrli50lbe
Where comm'M msY le&in Trees
❑FedEx1DaoFreigh FedEx 20ayFreight ❑FedEx3Oay ?eight
915 10TH ST PRINT SHOP ° 'yts [7;Second business eey th dtee;m�y
Address •Gee tor Confirmation. _.
DapiteloortSiivOloorn
5 Packaging •Deelered inikee.nil nee
GREELEY CO 80631 �/
GOY State ZIP I](l FerlEx Linter* ❑ FedEx Pak' ❑ Other Pkg. .1
7� Ncludn Fees Bo.hide
tea end customer pea Z
2 Your Internal Billing Reference i
F;91?Marsden will appear m remit+. 6 Special Handling w
3 To Saturday Delivery Sundry Delivery HOLD Weekday HOW Sabeday •
o
Recipient's r r, ( �s ) /�` ❑a.a Overnight y ❑Overnight*aNtosele tOPcodes ❑Not Location ❑ er -e
Name .4,11161- LllfL�/Ll 't./�1ej1 .1L/dv Phone(3K )1 � _LT (X) myletxZIP codes fe ernlMwn pM OvernightandfedEn X4y ea
to Wed beams as
Done*shipment co9dsin dangerous goods? <
J n` Ong boa must ha checked. - -.__...._. . C
CompenY s/Orn�►D p i rfine}14 o (a Relief')a j'1 II e ❑No ❑Yes ❑ Yas i E Dr'lce " A
us per enechs0 Shlopah Drdanem DrY ea.t UN IRS re as
p ) �/i�{ Shippers Newel. not?seared
Address�u�/ / en
Dangerous Goods ramp b.ehsp.d;F.dupepk.p p. ❑ Cargo Aircraft Only o
�r[!e Sree>� �Q�Qm # JO _ Payment elffmr ks
0
N
We cannot deem to P.O.ban or P.O.ZIP codes Oept/fkor/5ukWAloae Erne,fedEx Acct No.a Cedenn G No.b.t.m.
Sender ❑Recipient ❑Third Party ❑Credit Card ❑Cash/Check
hoot Non Sernm l
MI be bleed.
To'HOW et Fedt.beatim. Pole neet No tea
prieh&a ea lure �j j� �/Q Cm&Card No. ow
Cie/ La.ke IA)Dn,.f (V State 01) ZIP iV_/q9.� Total Packages TDMIWeght Total Ordered Writ
NEW Peel and Stick FedEx USA Airbill --__._ S .00
FdE"u'°D°ly
See back for application instructions. tD.rbebltyaF�eedma100unessyou&dereehighervota.Seebacklotd.lal.
® 8 Release Signature SOro.gbartedw amr
e7mdaet.El;sa9a.a..
Questions?Call 1.800•Go•FedEx (800-463-3339)
Vials our Web site et www.fedex.com
ay using this Airbill suu agree tO the senoce conditions on the back of this Airbill ey Signing youautharireusm deliver lhIssMpnaMwMaAnhae'ripaigaMaa 359
and in our current Seneca Guide,including terms that Ems our lability and ogres to Indemnify and sold us harmless from any rouble
0095378134
5145 394.RV 00ts Ill e• IN USa
•
LEOS HUT 05/71 564
LEO K WARDMAN .
82011 HWY 85 CTY R0126 2S-7/1020
CARR,CO 80612 Date ,5—,. ....9'h/
Pay Order of /& �y ��
Order of ` �^ 7r �� � $'
.5-2' ollars i c . "
CO' eo
WELLS BANK WEST,NA.
g \\Ill l l GREELEY
a 1026 NINTH AVENUE
I I \I r,i 5 GREELEY,co Bassi
www.wallatrgo.aom
is
Memo �J --"` te .
t
• :. ;
S .i:
lt'
U.S. Postal Service
CERTIFIED MAIL RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
ru
Ln
on
It] Postage $
✓R
fil Certified Fee
Postmark
Return Receipt Fee Here
r-R▪ (Endorsement Required) _-
O Restricted Delivery Fee
O (Endorsement Required)
O Total Postage a Fees $ 5- (' O(
ru
117 Recipient's Name (Please Print Clearly)(To be completed by mailer)
O `.1
_fie- ?t. ourrPBoxNo( L � ._il/�T
O Street,Apt.N No.;or PO O Box
O Dufe LA 143/1.41.2atj.._s�.'
O Clt,State,ZIP+4 -
i , 6'•
S F.rm 3:,,,Feruary 211, Se 'averse for Instructions
SENT E': Ca M'LETE THIS SECTIIN COMPLETE THIS SECTION ON DELNE'V
• Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of Delivery
item 4 if Restricted Delivery is desired. I n'u', O 5,i s-DI
■ Print your name and address on the reverse
C. Signature
so that we can return the card to you.
• Attach this card to the back of the mailpiece, X � ) • O Agent
,/
or on the front if space permits. � W 'r%X44'D Addressee
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑ No
Mrs. Leo ILCard man
Leos Nut
,Quit 66 f✓dhWaV, 85
Carr, CC 806,/a 3. S rvice Type
l Certified Mail ❑ Express Mail
❑ Registered %Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery?(Extra Fee) i]Yes
2. Article Numb€r(Copy from service label)
7900 D5 t, to/i7 ea/a 85.07y
S Form 3811,July 1999 Domestic Return Receipt 102595-00-M-0952
Hello