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Home My WebLink About20001941.tiff RESOLUTION RE: APPROVAL OF RENEWAL APPLICATION FOR TAVERN LICENSE FROM SIPRES LOUNGE, INC., DBA SIPRES LOUNGE - EXPIRES SEPTEMBER 4, 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, Sipres Lounge, Inc., dba Sipres Lounge, 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 has 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: 1490 Weld County Road 27, Brighton, Colorado 80601 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 2000-10 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 September 4, 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. cc .. AIN SO 2000-1941 LC0028 RENEW LIQUOR LICENSE - SIPRES LOUNGE PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 14th day of August, A.D., 2000. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: I ��'� araJ.jirkmeyeair /OA? /� Weld County Clerk tot o. . �J 1851BY: Jd�OG k.'"; A. . e e, Pro-Tem �I Deputy Clerk to th rF APPPOVED AS T. �1 %O Dale K. Hall aunty Atto EXCUSED Glenn Vaad 2000-1941 LC0028 THIS LICENSE EXPIRES SEPTEMBER 42001_ _ r - LICENSE E _____ __ _ ,,,,,i,mia=, -_ , ' - a'`STATE OF ' e .COLORADO COUNTY OF WELD BYAUTHORITY OF THE BOARD OF COUNTY COMMISSIONERS R ■uT' . iW TAIL LI(�UOI� 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 Xbil% to to Certtfp, That Sipres_ LQupge,_ Inc„ _dba _Sipres_Esauuge 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_Qrle_Hundtest_Twenty_f ivf._arul_001109 ($ 125.00 )Dollars therefor, the above applicant is hereby licensed to sell Slalt,_V_innus, _and Spirifuous 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 149Q WC$ 2Z> Brighton,_C.0_ $4691 _ _ _ _in the County of Weld,for a period beginning on the 5th day of September 2000 , and ending on the_ 4th_ _ _ day of September , 2001,.,unless this License is revoked sooner as provided by law. This License is issued subject to the Laws of the State of Colorado and especially under the provisions of Article 47 of Title 12, Colorado Revised Statutes,as amended. IN TESTIMONY WHEREOF,The Board of County Commissioners has hereunto subscribed its name by its officers d authori ed s Gah of _ _ Qugu$.t 2040 h � t£ ATTEST: 1 `' a e Board of Court C ssioners -. asN Deputy Clerk to the Board Chair,Board of County C , nucctonen t \VC' -1--;,, THIS LICENSE MUST BE POSTED IN PUBLIC VIEW JR 8402 tJ2•93 STATE OF COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division 1375 Sherman Street Denver,Colorado 80261 • SIPRES LOUNGE INC 11490 WCR 27 i BRIGHTON CO 80601 ALCOHOL BEVERAGE LICENSE Liability information Account Number I County City Indust. Type Liability Date • LICENSE EXPIRES AT MIDNIGHT 03-69427-0000 03 206 005813 C 090595 SEP 04, 2001 Type Name and Description of License Fee 2010 TAVERN LIQUOR LICENSE - $ 50.00 MALT, VINOUS, AND SPIRITUOUS • • 2190 COUNTY 85 PERCENT OAP FEE $ 425.00 TOTAL FEEIS)f $ 475.00 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 licerse 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. (Zr AUG C. 2 4 2fferf Division Director Executive Director _cerse `;.r^aer _!cense Type `9 3400 lc 35, LIQUOR OR 3.2 BEER LICENSE O3-69427- OOOO , 2O1O COLORADO DEPT OF REVENUE LIOUOR ENFORCEMENT E VENT D ViSiON 1 RENEWAL APPLICATION Liability'.nformat,on {DENVER CO 80261 03 206 005813 C 090595 SHERMAN Business Location 1490 WCR 27 SIPRES LOUNGE INC BRIGHTON CO 1490 WCR 27 Current License Expires BRIGHTON CO 80601 SEP 04 , 2000 • PLEASE COPY FOR YOUR RECORDS /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 the EThere 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 public corporation, DR 8177 - Corporate Report of transportation system license renewals do not need Local Changes; or if a Limited Liability Company (DR Licensing Authority approval and must be returned directly to 8405). All other changes of ownership require a the Colorado Department of Revenue at least 30 days prior to transfer of ownership application. See your Local the current license expiration date. Licensing Authority immediately. I FAILURE TO FILE THIS RENEWAL AT LEAST 45 E 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 f BEING RENEWED. want the permit to be issued. :. OATH::OFAPPLLCANT: ... • . 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 Business Phone ._,..17) -C.:)144.,- Z-I '%-- /-7-4..717 �7b Title of Signer(i, orporation) Sales Tax Number - OVAL OF LICENSING:AUTHORITY The foregoing application has been examined an s conducted and character of the applicant are sati yam, ` and we do hereby report that such license,if gra ed, ' c•, . f,R,th provisions of Title 12,Articles 46 and 47,C.R. R1.' I2/� THEREFORE THIS APPLICATION IS APPROV'.. , V r v < `4d) Local Licensing Authority for {tj/C ^ . e , ! \-,-,:,:-.-ii,,, _ own/City E Cou t / t'f1��Y• Sign re / t('1!_ Ti ' - ' '•.,rd of I Attest• , ',��►�. i��:�., �`J ppi�t� �r , OT DETACH ` ,If If r'1'•O` �lmmissioners B • iepu C'i�-`�~�lh �► I rt / Lni.J\l - DR 8400 (08/95)COLORADO DEPT OF REVENUE LIQUOR OR 3.2 21 BEER LICENSE 1375 SHERMAN ST DENVER CO 80261 RENEWAL APPLICATION Business Name I LICENSE NUMBER(Use for all reference) RENEWED LICENSE EXPIRES AFTER SIPRES LOUNGE INC 03-6942.7-0000 09-04-01 TYPE OF LICENSE ISSUED I CASH FUND STATE FEE TAVERN LIQUOR LICENSE - COUNTY 85% OAP MALT , VINOUS , AND 2320- 100 ( 999 ) 2010-750 ( 999 ) 2190- 100 ( 999 ) SPIRITUOUS $ 25 . 00 $ 25 . 00 $ 425 . 00 SUB-TOTAL $ 475 . 00 ADD $75 . 00 TO RENEW RETAIL WAREHOUSE STORAGE PERMIT 2210- 100 ( 999) $ TOTAL AMOUNT DUE $ Make check payable to:Colorado Department of Revenue 2000-1941 LC0028 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.Op'rating Manager ) Home Address / Date of Birth /4(R r / 47Y� Lt;��,� .77y-!„4,' lr 7F`) 7_ r "�� 2. Do you have legal possession of the premises for which this application for license i/made?C Yes No Are the premises owned or rented: _ If rented,expiration date of lease: Pq Li 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 filing of the 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 U 1K 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 I„_, 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 may not be renewed.Contact your Local Authority immediately. 8. Partnership applicants must answer this question.Since the date of tiling 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 I 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 ❑ license must be transferred to the new partnership and may not be renewed. Contact your Local Authority immediately. 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. II IX (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. O 53;1 (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. n (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 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 HOURS From: m. From: m. From: m. From: m. From:C74,0 ram. From: /1901 m. From: 7 P m. To: m. I To: m. To: m. To: m. To •'dc-; / m. To: La t) m. To ,'dC y m. CLERK TO THE BOARD WI p' PHONE: (970) 356-4000, Ext. 4226 FAX: (970) 352-0242 O P. O. BOX 758 GREELEY, CO 80632 • COLORADO July 20, 2000 Sipres Lounge, Inc. dba Sipres Lounge 1490 Weld County Road 27 Brighton, Colorado 80601 RE: County Liquor License Renewal Fee To whom it may concern: Our office received your renewal checks for State and County Liquor License Renewals and your Dance License; however, the County renewal amount is incorrect. I am returning this check to you and request that you submit a corrected check in the amount of$125.00 as indicated in the enclosed fee list. The remaining two checks are correct and I will hold them until your corrected check arrives for processing. If you have questions or need additional information, please do not hesitate to contact me at (970) 3564000, Extension 4226. Very truly yours, Esther E. Gesick Deputy Clerk to the Board P 387 472 470 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) ' Sent to.ss„.„. .,� , Sc. nd o Street a 7-1 /5/90 WC.2 .27 n P.O..State and ZIP Code N co 806,0/ ; postage, • S Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered to A Return Receipt showing to whom, Date.and Address of Delivery W S TOTAL Postage and Fees S 0 Cte m Postmark or Date n E u. D9- .?v o Co a ai SENDER: I also wish to receive the 2 •Complete items 1 and/or 2 for additional services. m •Complete items 3,4a,and 4b. following services(for an w •Print your name and address on the reverse of this form so that we can return this extra fee): card to you. W e •Attach this form to the front of the mailpiece,or on the back if space does not 1.O Addressee's Address o permit. '� w •Write"Return Receipt Requested"on the mailpiece below the article number. 2.O Restricted Delivery at .The Return Receipt will show to whom the article was delivered and the date W delivered. Consult postmaster for fee. p, o 3.Article Addressed to: 4a.Article Number 8 d Sipres Lounge, Inc. P 387 472 470 ¢ n dba Sipres Lounge 4b.Service Type 3 E g 1490 Weld County Road 27 O Registered ® Certified re Brighton, CO 80601 O Express Mail O Insured c O Return Receipt for Merchandise C ti p 7. Date of Delivery `o Q .Express 21 2000 cc 5. Received By: (Pont Name) 8.A ressee's Address (Onl if nested : H and fee is paid) m 6.Signatur (Address or Agent I- 15 o X /� • PS Form 811,December 994 102595-98-s-0229 Domestic Return Receipt LIQUOR/BEER RENEWAL REVIEW FORM Date: July 24, 2000 TO: Deputy Grein 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: AUGUST 7, 2000 ESTABLISHMENT: SIPRES LOUNGE, INC. DBA SIPRES LOUNGE 1490 WELD COUNTY ROAD 27 BRIGHTON, CO 80601 Current license expires: SEPTEMBER 4, 2000 ******************************************************************* **** * *i******************************* No concerns D'ep 's- ni ials 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. MEMORANDUM • � To: Esther Gesick, Deputy Clerk to the Board August 4, 2000 WIDC From: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Services COLORADO Subject: LC0028 Review of the following liquor license renewal by the Department of Planning Services shows the following: Sipres Lounge, Inc dba Sipres Lounge, Inc. 1490 Weld County Road 27 Brighton, CO 80601 Zone District: A (Agricultural) This use has existed prior to zoning and a Nonconforming Use File (NCU-80), has been set up by the Planning Department. No violations are occurring on the property at this time. SERVICE,TEAMWORK,INTEGRITY,QUALITY FecEx LISA Airba ll rzmkea 3225729511, "3 g�)V a�o0 3� as6r I 0 Dch;3.n',�memem may From 1pleaSeprittt) Express Package Service Packapasunder 15016s. nntamr,nsameareas. Date _8j22/2000 Sender's FedEx Account Number 1253-1948-3 I-- IFedfx Priority Overnight -IFedExStandardOvernight K1Fedtx20ay' ......-._ !__I(Next business murning) INevt business ehemonnl Isecond business day] O Sender's vv11__ a. S,,� � �,,�g 1970 • )356-4000x4225 NBry FedFx First Overnigqht •leg&r ennr Plate not nve.labe Name ---Ci.e rk.__tO._t11P.,_._,a2oaa_.... _ Phone ... tadieynealtxairtev manmgdelrvery la select locannnal Mnimumwaraae .. Ietaher tm.espyOne pmao FerEt 2Dav ten. COUNTY OF MELD Dept/Floor/Suite/Room I Cary_---- — 4b Express Freight Service Packages over tsoros aew:;in Batermt. • ❑FedEx Overnight Freight OFedEx2DayFreight I—IFedEx Express Sever Freight (Neat banners-day service 15eeond buutwssdav LJJ 111).to 2 business-day service t 915 10TH ST PRINT SHOP fa any antanrel service for any distance) based upon&alencel Address _.._—. .....__ ___.. _ ._... __._. ______.__ ..._._____.__.__ I Call for delivery schedule.See back for detailed descriptions of freightpraducls.l GREELEY C O 8 0 6 3 1 LI Packaging �FedEx ❑Pekes ❑FeduBox ❑T a El Other :a7r ..---- --_ _._...__..State _..__. 7 i _--_ _. LDeclaredWeeatrtla0.—d L� ©your Internal Billing Reference Information Itill ,opnonallttirsl 24 characters will appeal on await el ___..—_..._..__.__,..___.Y..._.. _ __. Special Handling ta<a..aarar tswWi Does this shipment contain dangerous goods? ❑Yes i ❑Yes noime.m I Li To(please print) ❑Dry Ice CAD Cargo Aircraft Only Recipients Dry lee,9,MI 18/5111 ---x Se 901 Name tDangenno roods Shipper's Declaration not relabel)] Liquoz En Io.rcetnent_._Diviaion.-___..f tone'.._3.03'205-2�QQ_.—.. Depufaor/Sdta/Roem UM Payment Bill f--1 Sender ❑Recipient ❑Third Party ❑Credit Card ❑Cast/ Company. ..Colorado—III► r'talent of Revenue__.__.___.-_ -- -- to: LNAICancpalnpe, check section l ma be billed) 1___ActorredEx account no.a Credit Card no Oebret� FedF.x Address _...._1881.P_3rar-.Ce.-Street --_--....Rnrnrl #108 _.-___. -._. unceuneNn _._..._._ ...__._..._._ ITO HOLD'at FedEx location,prim FedEx address hetet (We Cannot Deliver to PD.Boxes or P0.Zip Codes) Credit Exp. Card No. _--.._. _. _......Date__ _State__GO_hp_S.0214 Total Packages Total Weight Total Declared Value 1 tdthergai .- For HOLD at FedEx Location check here For Saturday Delivery check here s •-,f - HDIdWeekday Hold Saturday 1Nol available ate}locations) IEo eCMrpe tint •ah4lo n1 rennet • 3 ❑tam eueilahle with ❑Ike available with FedEx First Overnight or EIHoe allot In;FadEx first Overnight •When declaring a value higher Man 5,0e per shipment.you pay an aMFnonaI charge.See SERVICE "' Fed%rust Overnight) FdE,Standard Overnight e•Fadeu Standard Overnight) CONDITIONS,DEC LAKE lAtUE AND LIMIT OFUABIUTY section to.hetet inlormoion. Service Conditions.Decline'Value.and Limit of Unlink-By using this Arbil, actual loss in a ninety manner.Your right to recover from its for any lass includes inbieSic Li Release Signature Syyl rrr aeNNnne rkhwary without abler/my signature. you agree to the service conditions in ate current Service Guide or U.S. value d the package,loss al sales,interest.profit,attorney's fees,costs,and ether foams Government Service Guide. Both are available on request. SEE BACK OF d damage,whether direct,incidental,consequential,or special,and is footled to the SENDER'S COPY OFFRISAIRBILL FOR INFORMATION AND ADDITKINALTERMS. greaterofSIMorthedeclaredvaluebutcanmmexceedactualdocumentedloss.The y��vgrletENaaltMoriansFederalfprnsstedelivarthisship- — —�—�� — We will not be responsible for any claim in excess of 5100 per package whether maximum declared value for any FedEx Letter and FedEx Pak is 5500.Federal Express the result of loss,damage.or delaµ rein-detvery,misdelivery,or misinformation, may,upon your request,arduitl+soma lunitabens,refund all transportation Charges paid. mentwdharmless Federal(aprons Pontnyes sronoclnm unless mu declare a higher value.Pay an additional charge,end document your and hold harmless Federal Express tm any restrking claims. 272 See the FadEx Service Guide for Maher details. Rev.Dare 6/99 Questions? r �1 1 ' }' de £ecerss teeEt Call 1.800•Go•FedEx (1-800-463-3339) rite e �F` o r1',(1 On 7 i' ,n parlrtDrinsa • ter reel lion. M. :.___.... -_._.._-..... ._._._, .._ _......___ __- ,......_ __ _ I also wish to receive the SENDER: O .Complete items t srrn�c 2 I.i atlrllliclr I rvux follovvuig services ilex aes. w •Complete items 3.4e, d tho N •Print you name and address'at Ire re r e r it this form`e II al WI cur le ale-tin„ extra i to r '^ card to you. I. L� Addressee's Address o N •Attach th s tone te'relotl l the mad raa or on thebck I?a:dsrcl LL 2,L_. Restricted Delivery cn arpermit •Write Rre rum Heunpl icr.r sLd'o'. t e madpiece below tl di'le n.mbar. CoRir It postmaster ton lee- fi d'. •the Return Receipt w.1 star w In whom Ihr article was[Howled ar.d'h date __ _ delivered _ - _ -- —I 1-1 Article Number cf 3.Article Addressed to y i rx 1 r -' ' u _ >./'rP-? Byrn,i(-. ib Service Type m EE C. NI Cedlhtd ¢ " �] Registered co 1<� Cy(? e i,/ CCr7r'/L/ %O ❑ Insure I o / Express Mail m ' -, �'I t"rye['y� t4 Return Receptfrderchendlr, ❑ COD urr irr; ).L Otrer r' fR _--- 3. Addressee s Ar dress(Only}requested EIE y. Rcco,ved By (Fan'Rleme/ acid tee is Amid asr — - SEP1 2 ace it 6. Sig atu (f1 ress r � ap II __ eoszs DornestIC Return Receipt PS Form 3811, December 1394 w , `f cal CZa ' v S. It r w < a ,,,,,,a,„ ' w ¢ W i rt i 3� I 3 c L- Ai 47 LL i c O o tTt D , yr r•a '�°-yN` a - m a r. r _.' W b -, Fr L y a i 2 r_,,A a c. _,'v '' r g a wCC I v-r2 `. v oc In: a <r) w c car) T :' 4 sss-ecr-,ee, Od0 so 9861 aunr '0091 w1os Sd Hello