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Home My WebLink About20002484.tiff RESOLUTION RE: APPROVAL OF RENEWAL APPLICATION FOR TAVERN LICENSE FROM MRS. LEO K. WARDMAN, DBA ROCKPORT INN - EXPIRES DECEMBER 31, 2001 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 Rockport Inn, presented to the Board of County Commissioners of Weld County, Colorado, an application for the renewal of a Tavern Liquor License, for the sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only, and WHEREAS, pursuant to Weld County Ordinance No. 6, Section II, C., said applicant nas paid the sum of $125.00 to the County of Weld for the renewal of the existing license, and WHEREAS, said applicant has exhibited a State Liquor License for the sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only, outside the corporate limits of any town or city in the County of Weld at the location described as follows 62011 Highway 85, Road 126, 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 2000-14 to said applicant to sell malt, vinous and spirituous liquors for consumption by the drink on the premises only, 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 December 31, 2001, providing that said place where the licensee is authorized to sell malt, vinous, and spirituous liquors for consumption by the drink on the premises only, 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. 2000-2484 LC0018-B cc /1/,o; SC; C RENEW LIQUOR LICENSE - ROCKPORT INN PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 16th day of October, A.D., 2000. BOARD OF COUNTY COMMISSIONERS WE).D COUNTY, COLO ADO ATTEST: t 4! ;4A/�, \ /c---A24/7/4-//a L l4 EJ =LI ir V CJ \ , Barbara J. kmeyer, Chair '/ Weld County Clerk to th j-o. . v ' 00\ -, 7 jl`J/ 7 a , ..�nvisi M. J�Geile, Pro-Tern BY: > f r� 77 Deputy Clerk tote ?, (J .4 ` z" I —_— s Q orgt�E. Baxter -, 7 _r - APPROVED AST ORM: \ _—__ ) J 1 -'> — le . Hall 26unty Attorrhey .<1/ 11.1 GA4 Glenn Vaad__ 2000-2484 LC0018-B THIS LICENSE EXPIRES December 31 , - 2001 s :do-,,,, LICENSE FEE STATE OF Atar COLORADO COUNTY OF WELD BY AUTHORITY OF THE BOARD OF COUNTY COMMISSIONERS RETAIL LIQUOR LICENSE FOR Tavern SPECIFY: Retail Liquor Store,Liquor Licensed Drug Store.Hotel and Restaurant,Club.Tavern.Etc. TO SELL AT RETAIL Malt, Vinous, and Spirituous LIQUOR SPECIFY KINDS OF LIQUORS OW% i≤ to Certifp, That Mrs Lea R_ Wardman, dha Rnckpuri_Inn - -of the State of Colorado,having applied for a License to sell Malt, Vinous_, and Spirituous Liquors, and having paid to the County Treasurer the sum of One Hundred Twenty—five and 00./100 ($ 125.00 )Dollars therefor, the above applicant is hereby licensed to sell Malt - Vinous, and Spirituous _ _Liquors containing more than 3.2%Alcohol by weight by the drink for consumption on the premises only (Insert"by the drink for consumption on the premises"or"in sealed containers NOT for consumption at place where sold.") as a Tavern at 62011 Highway 85, Carr,_ CO 80612 in the County of Weld, for a period beginning on the_ _1st _day of_ _ _January , 2_001, and ending on the_ _ 31st _ day of December ,,2IQi._,unless this License is revoked sooner as provided by law. This License is issued subject to the Laws of the State of Colorado and especially under the provisions of Article 47 of Title 12, Colorado Revised Statutes,as amended. IN TESTIMONY WHEREOF, The Board of County Commissioners has hereunto subscribed its name by its officers du }authoriz tit' 16t day of October , 2000 1� f I „ ATTEST: `�� ! 1ii �� , f�',. T Board of County C mmissioners 5 ? wZ F 1 1F' ' By � p «tQ y '? Cki Chair,Board of Conn Commissio rs Deputy Clerk to the Board I Y1 �; ?, I *' 4 \; THIS LICENSE MUST BE POSTED IN PUBLIC VIEW DR 8402112,,991 STATE OF COLORADO DEPARTMENT OF REVENUE L.quor Enforcement Division 1375 Sherman Street Denver,Colorado 80261 WARDMAN LEO K MRS ROCKPORT INN 62011 HWY 85 RD 126 CARP CO 80612 ALCOHOL BEVERAGE LICENSE Llzb Ilty informatian -Account Numbe County �.ity Indust Type Liability Dates ' IGENSE EXPIRES AT MIDNIGHT I' 14-02037-0000 03 206 005813 I 123169 DEC 31, 20(11 Tripe . N ie xnA D s ot .,n o L tense rip 2010 TAVERN LIQUOR LICENSE - $ 50.00 MALT, VINOUS, AND SPIRITUOUS 2190 COUNTY 85 PERCENT OAP FEE $ 425.00 TO'AL FEEIE $ 475.OU 'I This license is Issued subject to the laws of the Slate of Colorado and especially under the provision of Title 12, Articles 46 or 47, CRS 1973, as amended. This license s nontransferable ana shall be conspicuously posted in the place abo described.This license s only valid through the expiration date shown above. Questions co-cerning this license thou d 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. /2 IM 1 Y OCT ? 5 ?op Ji Division D rector Executive Director { License Number CS 8400 110951 LIQUOR OR 3.2 BEER LICENSE 14-02037-0000 r 2J10 _ COLORADO DEPT OF REVENUE LIQUOR ENFORCEMENT DIVISION RENEWAL APPLICATION 1375 SHERMAN ST LIabdi'ylnfor.mation CENVER CO 80291 03 206 00581 3 . 12316 Business Location 62011 HWY 85 RE 126 WARDMAN LEO K MRS CARR CO ROCKPORT INN --._.. _ 62011 HWY 85 RD 126 Current License Expires [)EC 20 )0 CARR CO 80612 -- PLEASE COPY FOR YOUR RECORDS X This renewal reflects no changes from the last Application for renewal must be filed with your LOCAL application. Complete page 2 and file now! LICENSING AUTHORITY at least 45 DAYS PRIOR to ti'e [_] There are changes from the last application. expiration date of your current license. Complete and attach page 2 (DR 8401) and if a Exception: Wholesaler, manufacturer, importer. and put iic corporation, DR 8177 - Corporate Report of transportation system license renewals do nit reed Local Changes; or if a Limited Liability Company (DR Licensing Authority approval and must be relurred directly to 84051. All other changes of ownership require a the Colorado Department of Revenue at least 3f; lays p-ior to transfer of ownership application. See your Local the current license expiration date. Licensing Authority immediately. ''--FAILul-it 10 FICA I HIS I1ENEwAE—ATLEAST 45 1 Delivery Permit requested?Retail Liquor Store, DAYS PRIOR TO THE EXPIRATION DATE OF YOUR Drug Store or 3.2% Beer Combination On/Off LICENSE MAY RESULT IN YOUR LICENSE NOT Premises Licenses ONLY. Check the box if you BEING RENEWED. I want the permit to be issued. _____ _.__._._—.._. .__J .:: OATH OF APPLICANT . . . -- I declare under penalty of perjury in the second degree that this application and all attac'•:ments are true,correct,arid c cmc if to to t- best of my knowledge. Authorized Signature TDate 1 Busir,,3ss rn mne Title of gner(if cor oration) ; Sales Tax Number I:I:I. : REPORT AND:APPROVAL:OF LICENSING:AL1TNQRITY:.': - . - The foregoing application has been examined and the premises.business conducted and character of the applicant are satis � . // ,\',. and we do hereby report that such license,if granted,will comply with the previsions of Title 1 2,Articles 46 and 47,C.R.' `f —' —.� )' THEREFORE THIS APPLICATION IS APPROVED. /"...^ <-7140.. r� Local Licensing Authority for - Town/City L C u ty D •,Ir/�r 1 ' . , _ W ld Coun.ty.:-Colorado — -- — � „ Z 7 - - ' S ghature`_Title Chair, Weld County ! An ; r,, s`''•. • j-} a(k. ,./ r. exti;;/i_<. Board of Commissioners ev !)y A - /DO NOT DETACH / i DO NOT DETACH �D .p14•1'• OR 8400 (08/951 LIQUOR OR 3.2 BEER LICENSE 2 1 COLORADO DEPT OF REVENUE 1375 SHERMAN ST RENEWAL APPLICATION DENVER CO 80281 73us,ness same LICENSE NUMBER(Use for all ref•rencel i RENEWED LICENSE E<1:'FE AFTE ROCKPORT INN 14-02037-0000 _ 12- 31 - 01 TYPE OF LICENSE ISSUED CASH FUNDT S--ATE FEE TAVERN LIQUOR LICENSE - COUNTY 35% )AP MALT , VINOUS , AND 2320- 100 ( 999 ) 201{I-750 ( 999 ) 21c..0- 100 ( 7_-: )9 ) SPIRITUOUS $ 25 . 00 $ 25 . 00 i 425 . 0: SUBTOTAL $ 47 1 . 00 ADD $75 . 00 TO RENEW RETAIL WAREHOUSE S-ORAGE PERMIT 2210- 100 ( 999 ) $__ _. .__- TOTAL AMOUNT OLE $-_ _. ___ Make check payable to:Colorado Department of Revenue 463/87-. o7C2''�?"f,i 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 (-1 i��f' !r� _..v� �IJ [ ,T ' Gam c ? `/� '- 1.Operating Manager Home Address Date of Butt _ r0/7 c ex't: /I5 -C' Rl,' - -, C li! _ . 2. Do you have legal possession of the premises for which this application for license is made? Yes Are the premises owned or rented: On.cc „ i If rented,expiration date of lease: __._.. . _ _. L� j 3, Has there been any change in financial interest(new notes,loans.owners,etc.)since the last annual application? If yes,explain in yes detail and attach a listing of all liquor businesses in which these new lenders or owners,(other than licensed financial institutions)are materially in'erested. [ -I I i 4. Since the date of filing of the last annual application, has the applicant,or any of.ts agents, owners,managers,principals,or lenaers Y'�s1 (other than licensed financial institutions),been convicted of a crime? If yes,attach a detailed explanation. [ j ` {' 5. Since the date of filing of the last annual application, has the applicant,or any of:ts agents,owners, managers,principals,or lenders (other than licensed financial institutions),been denied an alcoholic beverage license, had an alcoholic beverage license suspended or Y'Is ' revoked or had interest in any entity that had an alcoholic beverage license denied,suspended or revoked? If yes,attach a detailed 1 .___.explanation. E. Does the applicant,or any of its agents.owners, managers,principals,or lenders (other than licensed financial institutions),have a yes n direct cr indirect interest in any other Colorado liquor license(include loans io or from any licensee,or interest in a loan io any r 1 F licensee)?If yes,attach a detailed explanation. 7. Sole owners or husband-wife partnerships answer this question.Since the nate 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 iF=5 I' > company other than the licensee listed on your state liquor license? If yes,this license must he transferred to the new owner Lc)) Li may nct be renewed. Contact your Local Authority immediately. E. Partnership applicants must answer this question.Since the date of filing of the last annual license application: Yes .. (a) Are there,or have there been any general partners added to or deleted from the partnership?If yes,this license must be _ 1 I transfe'red to the new pannership and may not be renewed. Contact your Local Authority immediately. (b) Are there.or have there been any limited partners with a 1046 or more interest,added or deleted from the partnership? If yes,tl is r l license must be transferred to the new partnership and may not be renewec.Contact your Local Authority immediately. ' — 2. Corporate applicants must answer this question. Since the date of filing of the last annual license application: y..,g (a) Are there,or have there been any officers or directors added to,or deleted from the corporation? If yes,complete arid attach - I r DR 8177 and submit to your Local Authority immediately. [.- I ('o) Ale there, or have there been arty stockholders with 10%or more of the issued stock,added ro,or deleted from the corporation? _ If yes, complete and attach DR 8177 and submit to your Local Authority immediately. J (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 (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 mote membershio interest,added tc,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 12-47-119.5 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 1 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 HOUR` From: m. From. m. From: m. From' m. From: m. From: m. From: ni To: m.. To. m. To: m. I To: m. To. m. To: m. ru m LIQUOR/ EEC RENEWAL REVIEW FOAM Date: September 26, 2000 TO: Deputy Ron Richardson ='QOM: Kim Fliethman SUBJEC : Liquor License Check In accordance with the new procedure for Liquor and/or beer Icense anecks, please review all records on the following establishment for any associates repots during the last year and returr your report to the Weld County Clerk to the Board's Office with.n two weeks. Your report wdl be usec by the Board of County Commissioners in considerinc renewal of the liquor anc%or beer license. PLEASE RESPOND NO LATER THAN: OCTOBER 11, 2000 ESTABLISHMENT: MRS. LEO K. WARDMAN DBA ROCKPORT INN 62011 HIGHWAY 85, ROAD 126 CARR, CO 80612 Current license expires: DECEMBER 31, 2000 korkekkkkkk*kkkkkkkkxkkkkkkkxkkkkk=xkkxkkk*kkkkkkkrrkkkkkkkkkkk r k*kk#kkkkkk<#xkxkkkkkkkx.k<kkk#+kxkkkrk No concerns 4/2_.Deputy's Initials The Sheriff's Office hoc a concern and the deputy has mutually worker with the licensee to correct the concern, (Complete Attached Worksheet) Unresolved concerns exist requiring is Probable Cause Hearing scheduled by the Board of County Commissioners. (Complete Attached Worksheet) x**** k*kxk*kkkkkkkwk*kkkkkxkkkkkkkkkkkkkkkkkkkkkkkkkkkk.******kkk<*kk*****,,*******************kkkkkkkkkkk Please notify at Extension __ of the date and time of the Board of Commissioner's renewal hearing. � l_, MEMORANDUM 41,„ ,-;\) To: Esther Gesick, Deputy Clerk t the Board October 6, 2000 Wile. From: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Serii COLORADO Subject: LC0018-B Review of the following liquor license renewal by the Department of Plann ng Services shows the fo=Ice inn Mr. Leo K. Wardman dha Rockport Inn 62011 Highway 85 Road 126 Can, CO 80612 Zone District: Agricultural •This use is allowed through a Nonconforming Use (NCU-00271) for a Restaurant and Tavern. No violations are occurring on the property at this time. SERVICE,TEAMWORK,INTro,uTY,QUALITY • FedIEx. {.lf,i L JiirS.•ilt. Ntimhm 2 2 5 7 2 9 3 0:L_ 92 goo [�° e 6 CMil ''AA ";:g,';',''''2,Z,";;,)'.'s lar From(please print} WI Express Package Service Packages under 150las . 1253-1948-3 FedEx Priority Overnight FedEx Standard(hurl fight a.FedEt rl De • 'Nile 1.0/24/2000 Sender's FedEx Aecohnihlumber �eNn,uuneaenraalt L�tNe.lmelnnswernn,a! Isenmd,t. ..:I.ryl • Sender s 1f '.FedEx First Over hl F,terse to m. /Clerk.to the_Board -.. 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Does this shipment contain dangerous goods? .iy'I'' awp.ry Iy' '•,elm.,:e III To(please print) [ Dry I Div ocIce UVIe151P axe ';A .;ar,nAI ElPly Recipient's 1 3031 205-2300 tuen:Sinn+rode Sisprr s OS♦.+lal.•.rnr,lgginirel" • r Naner Li.quor.. Division.ivision . ..... Phnm+ .• El Dlept�lnor/Suit.(Room Payment Bin ( Sender '- .... Caste Com aroloado Depar.tmnent o1 Revenue to: Iv 1laa w v:.ern IRecoplere I Iheiloi C ddCaM Cheri ty C >i —fEMa redFelrJamra [�•r.rd.n ••u.r_�.-- lEa Address .. 1881 Pierce Street Room...#108 .. .. .. . ... .. Ae+rlrEy .. (To'1WO'ot red Erbeam•ie.prim TadFe add,c es h.'el art Cnu rol Detre,to PO Ruler:Ia Pr 71p COclisr Node er .. . . Ia•n - City LAKEWOOI) ..- ... . ._ slaid.. CO . ay-. .80214 _..__ Total Packages Tot.?Weight Total Declaredvelmr' Total(.areas For HOLD aatteFeedfx Location check here For Saturday Delivery check here `• Ili S I�Hold'Weekday Hold saliede tom arch LA or.III lecenmsl (Urfa Cra•oe.'Inl robin to al logs'pod •'A Mir..dn,,'mgYrJ.,ehiprn,h rn S"+IrYe:hVne J.ya,I•:::Jde .al I1• .:a ter I.E --•. —_--- ;NMewJas6sMh n(Nfix Soida Roll.first 0Vara,alln, `I iNdara l+NarwM Margoray nsllMn,gn c0adiTll'INSoECUKE0 YKwl AND NWT Of llsaiEm s.arm In.'at"INt.Ia,.,I foommommt redEr Hn dyam.pml sanfe Reedard Overny mi m re,rTa Slandaro die„xghml Service Conditions.Deemed Whin,and Limit of Whity—By using lids Alba. erh albtit.urknlrrylne.rfr):;urryin toroc„yen donut lnrarry,150 nr.lys int'mic D Release Signature . .;,.•r,,. .. . . . .. you agree in der servir.r•,condtimis jot our car,ant Service Giude ter LI.S. valued(diaryackale,lossofsalagimeresl,proit,attorneyslens.oasts,ai9odme.lnrnx Goyennne"t Semen G,rde. Bodh era evade*,nn request SEE BACK OF of damage,whether direct,inl:Idenial,carrselpeoelal,el special,and is"Witted to Pee SFN]ERs i:orY onus Amino.FOR INFORMATION AND ADDITIONAL TEnms. Snider oI Slat at the denial el:eaiva but calve'wowed',dual dumber-oil kiss The ysers•a'I.u:e,udheneasma,..0 t.e.eu l..,Oiv.0a.ar'p We will not he responsible fix rig claim in excessdSMM perpacN•rge whether mosenor,dertired vales lossany Fr-dEx Letter and FedEa Pak i MO.FO PenniErno-. p+nnte•d,::In nytai.•al9 aslenatur:.a.dagtees,a find,,myth iii,'LIPID el limb damage.0s delay,non-delivery.orentefiuery,a misinformation, may,Ilponpen,egrgtLaM with wow i+litMi.rls,rah Ind all tramyorlal on;hargvepaA. awl hold•m mace rede.si torah..Ire try',salting:labile m Ile SS VII deaste a legher vales.pay an uddilanal charge,and docurnem year See the frail a Sluvhar n.;le I or cumin.lletuils, 1D7t3' Ln. Questions? / 1 j r T a ru' IP, Call 1.800'Go•FedEx (1-800-463-3339) rTj (' fit/0 ri ` (U)n' rill, I, 1 •l:•,, P 38? 4711 875 RECEIPT FOR CERTIFIED MAIL. .11)IN5uuANCE G0VEFACL PRovIOFo NOT FOR INJERNAI°NAL MA (See Rev,yap) Fa' _ A): — F..) u� I I ( tatr an t I, tae w tau_ j`G /�i-- - 1 :rsra<1e or F le ,t .II DI Ivery I ee L r tea!)a , Frit .•Il il'i rte ci), r,-t v r.tnl ci d I)]I rl( iv-,,e mRe e,,,, tw +ld /et cl UvFV ytr c "AI di .lagc,!)d F ecs. -- co n t.. y SENDER: I also wish tc ecelve I i V •Cc mp:te items l a 1 P In-: 1 nl:,I soV-o rs. IollOyvlrn r; -es l rr ]'t _y •Cc np to items 1 n anti 41 3 '1 CD m •Print your name n lilies.u, n n versed this tom,so lhet ..ru ri tlo n th:s extra lee) car J c yon w •At this`orn A t c tr lot of 0 i ail,,eco. on Ihn back it spice dues ii 1. ❑ Addl saes Al tr rso a, Permit le det.iiii PfTe I li=quor, I n 'iv man piece be low toe article r nbo, 2. ❑ Rest'fled F.e11VSr< no •he R(turn lies Ipt v I ,how it "Al n the article was celivered and Inn dale u) de ve cd. :-O,1sull po',t1 idS1e' tpt In- C L. O 3. Article Addre s II to Ta Article Nunbel a i ,< / c : /Lief / ) P' ._14 l `/Y/ 1 r L: k--10 ri i q, <;t•rvice iy)e coy L -5.( // // ij�lr f., l ,�.,j iiiad ioiL lL7 R„glslelet � e t c T r-, L] r axe s L'?art I III ,t E C�a17- C1(' .I C.v� RnHnn Rcc,Iptlor Me'Clm. - I_' i lI 1Ame of eel,ye ry G j i It /i•Jcr 1 ce Fie( ive,IB Wirt Nan B Aotirs.saee s Address (CI'v rt ((71t ( 1< fS I"'� -� Leo �� it c{I lt�rnMil rree did) F' w CC 6 Sig (Mr', (Adrrressee^• Age Ill / ± PS -orm 11, :Le r Iri s Ira e, 48'.c.'pq '.)omestic Return Receun P 387 471 876 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) 141 Sent tRR/rIr5, Leo Weird✓Aa fl Koa&porf -rirn7 m Street and No =' bao/ icay:fs Rat// a P O State and ZIP Cli de N Carr (10 8C&,/a P Postage r S Certllied Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered us 40 a,, Return Receipt showing to whom. Date. and Address of Delivery N C TOTAL Postage and Fees 5 d O Postmark or Date 1/—//7/- /� /) S A/-/�_e)Cl E `o LL N a % SENDER: I also wish to receive the D .Complete items f and/or 2 for additional services. following services(for an m .Complete items 3,4a,and 4b. 9/ •.Print your a name and address on the reverse of this form so that we can return this extra fee): 0 card to you. 1.❑ Addressee's Address u W •Attach this form to the front of the mailpiece,or on the back if space does not '2 permit. 2.O Restricted Delivery d .Write"Return Receipt Requested"on the mailpiece below the article number. CO 2 .The Return Receipt will show to whom the article was delivered and the date Consult postmaster for fee. 1i 4-1 delivered. '8 0 3.Article Addressed to: 4a.A icle Number a0 Airs, leo I7 rdm�ci/ 3£ 7 '7/ 12.7 CC d 4b.Service Type E cU E'�j or��// �'')nrr�'L 1,'A7,, / O Registered Certified ell u ,Qo// 44 1a)a 7 aeS r'riad/07(O ❑ Express Mail O Insured C m a rr1 X Pee/4 ivy Return Receipt for Merchandise O COD L CPO' .- `1 �7.`Date of elivery w a 1 //1 to/ � 0 5. Received By: (Print Name) 8.Addressee's Address (Only if requested ,/\„ I _ O ( (l� 1 rnQ and lee is paid) t Y IX �/�./ YO. F 6.Signature: (Addressee or Agent) IS X /LO 04197/(2ie ..v m PS Form 3811,December 1994 102595-9e-B-0229 Domestic Return Receipt Hello