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HomeMy WebLinkAbout940760.tiffRESOLUTION RE: APPROVAL OF RENEWAL REQUEST FOR 3.2% BEER LICENSE ISSUED TO CONO-SERVICES, INC., DBA CONOCO #06355 - EXPIRES OCTOBER 9, 1995 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, Cono-Services, Inc., County Commissioners of Weld County, a County Retail License for the sale more than 3.2% of alcohol by weight, the place where sold, and dba Conoco #06355, presented to the Board of Colorado, an application for the renewal of of fermented malt beverages, containing not in sealed containers not for consumption at WHEREAS, pursuant to Weld County Ordinance No. 6, Section II., C., 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: 12435 Weld County Road 2, 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 94-10 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 Chairman 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 October 9, 1995, 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. 940760 1— (' cc I ) RENEW 3.2% BEER LICENSE - CONOCO #06355 PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 25th day of July, A.D., 1994. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COkORADO ATTEST: Weld County Clerk to the Board BY: eputy C ear to the Board APPROVED AS TO FORM: County Attor ey Constance L. Harbert /Barbara J. Kirkme}ier 940760 THIS LICENSE MUST BE POSTED IN PUBLIC VIEW DR 8402 cZ 110192) STATE DEPARTMENT ALCOHOLIC OF COLORADO OF REVENUE Liquor Enforcement Division 1375 Sherman Street Denver, Colorado 80261 CONO-SERVICES INC CONOCO N006355 12435 WELD CO RD 2 BRIGHTON CO 80601 BEVERAGE LICENSE Account Number Liability information LICENSE EXPIRES AT MIDNIGHT County City Indust. Type Liability Det• 21-35816-0051 03 206 5541 C 101089 OCT 09, 1995 Type Name and Description of License Fee 2122 2190 3.2 PERCENT BEER RETAIL LICENSE (OFF PREMISES) COUNTY 85 PERCENT OAP FEE $ 50.00 $ 42.50 TOTAL FEEISH This license is issued subject to the laws of the State of Colorado and especially provision of Title 12, Articles 46 or 47. CRS 1973, as amended. nontransferable and shall be conspicuously posted in the place above described. only valid through the expiration date shown above. Questions concerning be addressed to the Department of Revenue, Liquor Enforcement Division, Street, Denver. CO 80261. testimony whereof. I have hereunto set my hand. G SL 1/4%avi AIM 0 2 WI Division Director Executive $ 92.50 under the This license is This license is this license should 1375 Sherman ez Dire for 940760 O O en 0 O O U ‘.6 L O O W a 1I1 C4 a. tn z z z 0 z O U O THIS LICENSE EXPIRES 60 DR 8400 (8/89) Colo. Dept. of Revenue Lquor Enforcement Division 1375 Sherman Street Delver, Colorado 80281 888-3741 Liquor or 3.2 Beer License Renewal Application S€RV36 1'C&CS !'G C% 4784 lily : ) T7.7'1C'4.754 License Number: 21-35 616— 0 , Liability Information: !ll ? qty :`i54C 101039 Business. Location: 12435. rf_L{O C"•, r i License Type:. 2122 Current License Expires: JC T 39, 1994 i CU' r u V/ OOMMfl COPY YOUR PROMPT ATTENTION IS REQUIRED. FAILURE TO COMPLETE THIS FORM ACCURATELY AND PROMPTLY MAY RESULT IN YOUR LICENSENODQEMWQ RENEWED • FILL OUT THIS FORM -COMPLETELY AND CHECK APPROPRIATE SOX BELOW. t 0 This renewal reflects no changes from last application. ❑ There are changes from last application. (Report changes on form DR 8176 - "Report of anps: Ljguorand 3.2 Beer Licensee" and attach that form to this renewal application. SIGN THE FORM ENCLOSE TOTALAMOUNTRUE SUBMIT FORM TO LOCAL"fgTT/COUNTY) LICENSING AUTHORITY FON APPROVAL CHECK VAIN LOCAL AUTHORITY FOR AMOUNT OF LOCAL FEES. Author' natur A _ ..- Date: //..,, 4✓'/� /A [-1 Business Phone: i i , J c(3 -)7 co Tate of Sign corporation) `?'i!F'_� / Sales Tax No. ai-z,, ..off, - - ' ATTACHED DR 84Of MST RE COMPLETED (ALL 3 COP/ES) SUBMIT THE. STATE COPY AND LOCAL (CITY/COUNTY) ' AUTHORITY COPY TO YOUR LOCAL (CITY/COUNTY) LICENSING Ak1T}IORI— NO LATER THAN 45 DAYS BEFORE YOUR LICENSE EXPIRES. EXCEPTION Wholesaler, manufacturer,importer, and public transportation system license renewals do nbt need Local Licensing Authority ,•roval and must be returned directly to the Colorado C of Revenue no later than 30 da $ • • r to liense„ 'ration. The foregoing application has tory, and we do hereby teeter TREFORE THIS APP1.L'CA Local Licensing Authority fort- WELD COUNTY, v COLORAD&- 0 /� ❑ TOWN/CITY g COUNTY Signature: 4 K ' y' t -.• -��1 • ^'y�,, Title CHAIRMAN{, WELD COUNTY BOARD OF COMMISSIONERS Attest rry' -L{Y: CJ•SG�k /L(.4J1t*) Date R. 07/25/94 DEPUTY CL TO BOARD n examined and license, if. NIpROVE Premises,business conduSted and character of the applicant are satisfac- Id, w8( comply with the provisions of Title 12, Articles 46 and 47, C.R.S. 'Pc Nor DEciEH ' do �4T t>¢"Ii - `•V'!`P" t NQT @ETACH •. DD NOr OE ACH DO N3T CEYACO • DO NOT DETACH • .Oo NOT DETACH • DO NCTDETACH 14 I1TON Cr. NAME: USE LICENSE NUMBER FOR ALL REFERENCE LIABILITY INFORMATION RENEWED LICENSE :-EXPIRES AFTER COUNTY CITY INDUST. TYPE LIAB. DATE ( Cm ti.:Cr, 1d1t0b3 21-5513":"-051 0$ 20C, 5541 C 101040 1;S-"9-"ir. TYPE OF LICENSE ISSUED CASH FUND STATE FEE CITY 85% OAP CO 85% OAP 48.01 (9) ; 414 (9) 45-9 (9) 37-1 (9) 49.1 (9) 3.2 01 4', o(T ".c :. t. 1L 11CtNSt ('UF k:""1SES) E 25.00 3 25.0E 47.50 Make check payable to: COLORADO DEPARTMENT OF REVENUE,:. TOTAL AMOUNT DUE * F 92 • ` r EXTENDED HOURS — Applies only to Hotel and Restaurant, Beer and Wine, Club, Tavern, Extended hours? and Arts licenses. If desired, cheek yes" and enclose Total Amount Due PLUS $170.00. ❑ Yes 0 No #9177-70 LC 00!l 940760 Oaemn preq Attachment t Liquor/3.2 License Reny /al Application _ This page must be completed and attached to your signed renewal application form. J,.��..� whh the • pllntbn Tay rewlt In Your Ileenrw not being renewed. Fdlure to Induce thle page P Trade Name of Establishment Conoco State License Number 21-35816- 0x1 1. Do you have legal posession of the premises for which this application for license is made? YES [X NO LI Owned it rented, effective and expiration date of lease: N/A Are the premises owned or rented? 2. V' "-- the applicant or any of the partners, or officers, stockholders or drectors of said applicant (if a corporation) ever been YESL! NO 3 convicted of a crime? If answer is yes,' explain in detail and attach. (b) Have persons letting assistance or financial support to the applicant, or manager, or employees, ever been convicted of a crime? YES Li NO 3 tf answer is yes,' explain in detail and attach. 3. Has the applicant, or and of the partiles, or officers, dracors or stockholders of said applicant (if a corporation) or manager, ever: (a) been denied an alcoholic beverage license? YES L NO (b) had an alcoholic beverage license suspended or revoked? YES DC NO ❑ lc) had sinterest in any entity that had an alcoholic beverage license suspended or revoked? YES [Y NO E See Attachmoil ;Renter{ above questions. "Diann detail and attach. ,Vary 4. Does or did appicant, or of the partners, or officers. drectors or stocldnners of said applicant (if a corporation), have a direct YES; NO ;_; 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 answer is yes' explain in detail and attach. See Attachment #2 5. Identity the persons, ferns or corporations who now or will have a finanGal interest, evidenced either by a loan to. or entity ownership in. the business for which this license is requested. State the names and addresses and the anent and source of such financial interest (i.e., bank. relatives, friends, previous owners, etc.). expressed in dollars or other items of value. such as inventory, 'endure or easement Use separate sheet if necessary. Nye Conoco Inc. Address F. U. box 4784, TR 3032 Houston, TX 77210-4784 Mterest 10096 Type and Arnaud — 6. Mbonkattriperriwittre et names and addresses of as liquor businesses in which arty of the persons in question No. 5 are materially interested. 7. Operating Manager T }il tg--A 934k IFIeT Address • 13ClcO ‘2\11ti1G CT t fiRDDMRRELt1 OGUX Date of Binh `'tx-7 /CPO 8. If partnership (except husband and wife , 1st as general partners. Use separate sheet if necessary. Name N/A Address Date of Birth Name Address Date of Birth 9. )(the applicant is a corporation, answer the following: (a) Corporation is organized under the laws of the State of: Colorado Date Incorporated 1/14/82 lb) Principal place of busness is:Colorado (c) Date of fling last amual corporate report to the Cob. Secretary of State: 4/1/92 (d) Name of each officer listed below: Prxsdwt H. 13. Merchant Hoene Address 16210 Peach Bough Lane, Houston, TX 77095 Date of Birth Y�"pr Home Address 20118 Chateau Bend Dr., Katy, TX 77450 Date of Birth Tr D. C. 20118 Chateau Bend Dr., Katy, TX 77450 Date of Birth Secretary J. G. Address 3650 E. White Bay Dr., Highlands Ranch, CO 80146 Date of B rth le) List all over. (d a public corporation) including actual owner or -pledgee. (Use separate sheet if necessary) Name Conoco Inc. Address O. Box 4784, TR 3032, Houston,TX Percent of Stock 100% Date of Birth Name address Percent of Stock Date of Birth Name Address Percent of Stock Date of Birth (f) Name of all Directors'/Trustees of Corporation N See Above List of Officers (Merchant, Address Rising & Fuqua) Date of Birth Name Address Date of Birth 94076O Cono-Services Inc. Violations which have resulted in suspensions of the license 12-84 Jefferson County Ten day suspension for sale to a minor. 3-90 Arvada Five day suspension for sale to a minor four of which are held in abeyance for 12 months. 9-90 Thornton Two locations, ten days suspension each; five to be held in abeyance for one year, a fine in lieu of suspension of three days, and two days actual suspension. 3-91 Dept. of Rev. Store 406326 in Denver received a one day suspension for failure to conspicuously display the liquor license, a fine was paid in lieu of suspension. 6-91 Longmont Store #06356. Received a 10 day suspension for sale to a minor. Paid a fine in lieu of suspension. 7-91 Broomfield Store #06370 Received a 7 day suspension for sale to a minor. 4 days to be held in abeyance for one year and a fine was paid for the other three days. 12-92 Denver 1-93 Denver 2-93 Broomfield 7-93 State 8-93 Denver 10-93 Broomfield 4-94 Boulder County April 23. 1994 Store 06421, received 10 day suspension for sale to a minor, held in abeyance. Store #06333. Received 10 day suspension for sale to a minor 8-92, held in abeyance. 1-93, Fine paid for tO day suspension, 20 days to be held in abeyance, for sale to a minor. Store #06412. Received 7 day suspension for sale to a minor. Four days held in abeyance, fine paid in lieu of remaining three days suspension. Store #06430 (Westminster). Received a 3 day suspension for improper posting of a minor warning sign. Fine paid and two days held in abeyance for one year. Stores #6351, 6418, and 6335. Received 10 days suspension at each location for sale to a minor. Seven days were held in abeyance for a period of one year and a fine was paid in lieu of remaining three days suspension. Received 21 day suspension for sale to a minor. Ten days held in abeyance, a fine was paid in lieu of suspension of four days and seven days suspension were served. Received 5 day suspension for violation of §12.46-112(1) (bxl), C.R.S. Two days held in abeyance and three days served. 940760 CONO SERVICES INC P.O. Box 4784 - TR 3038, Houston, TX 77210-4784 73-1143039 STORE N0. ADDRESS CITY ZIP Colorado *06302 *06307 *06308 *06309 *06310 *06311 *06312 *06313 *06314 *06315 *06317 *06318 *06319 *06320 *06324 *06325 *06326 *06327 *06328 *06329 *06330 *06331 *06332 *06333 *06334 *06335 *06336 *06337 *06338 *06340 *06341 *06342 *06344 *06350 *06351 *06352 *beer only rev 9/93 601 South Broadway Street 14490 East 6th Avenue 6724 W. Canyon Avenue 12001 East Iliff Avenue 11090 North Colorado Blvd. 5091 South Jellison Way 15351 East Iliff Avenue 1191 S. Buckley 4490 Peoria St. 9175 Harlan St. 11515 N. Highway 83 8170 W. 80th Ave. 19001 E. Quincy Ave. 16810 E. Quincy Ave. 8073 S. Broadway 5810 Omaha Blvd. 3434 W. Alameda 10210 E. Arapahoe Rd. 4140 Date St. 279 S. Federal Blvd. 1705 W. Uintah St. 4310 Fountain Blvd. 2350 Hancock Expressway 502 Sheridan Blvd. 3210 Youngfield 1501 Colorado Blvd. 14501 E. Colfax Avenue 13690 E. Alameda Pkwy. 7444 West Chatfield 290 S. Havana 1985 Kipling Street 4315 N. Academy Blvd. 1100 S. Havana 7199 N. Federal Blvd. 3550 Downing, Unit C 4200 N.E. County Line Rd. Boulder Aurora Littleton Aurora Denver Littleton Aurora Aurora Denver Westminster Parker Arvada Aurora Aurora Littleton Colorado Springs Denver Englewood Colorado Springs Denver Colorado Springs Colorado Springs Colorado Springs Denver Wheatridge Denver Aurora Aurora Littleton Aurora Lakewood Denver Aurora Westminster Denver Erie 80303 80011 80123 80014 80233 80123 80013 80017 80239 80030 80134 80005 80016 80015 80120 80915 80223 80111 80917 80223 80994 80909 80910 80223 80033 80220 80123 80012 80123 80012 80215 80917 80012 80030 80205 80316 940760 C0NO SERVICES INC P.O. Box 4784 TR 3038, Houston, TX 77210-4784 73-1143039 STORE NO. ADDRESS CITY ZIP Colorado (continued) *06354 *06355 *06356 *06357 *06358 *06359 *06360 *06362 *06363 *06364 *06365 *06366 *06367 *06368 *06369 *06370 *06372 *06373 *06374 *06375 *06376 *06378 *06377 *06380 *06381 *06382 *06383 *06384 *06386 *06390 *06391 *06393 *06394 *06395 *06396 *06402 *beer only rev 9/93 3809 Mulberry 12354 Weld County Rd. 1801 Hover Rd. 1260 14th St., S.W. 5009 N. Garfield 3495 Fox St. 4981 E. 64th Ave. 1110 S. Pierce 14531 E. Alameda 7444 West Chatfield 5600 South Simms, Unit A 7130 County Line Rd. 774 W. 120th Ave. 1095 First St. 3375 28th St. 1601 Hwy. 287 1550 W. 88th Ave. 802 S. Public Rd. 2350 E. 120th Ave. 15900 West 44th Avenue 8113 W. 94th Ave. 10815 W. Jewell Ave. 7960 Niwot Rd. 230 Broadway 92 Poudre Canyon, Hwy. 28 Hwy. 287 & N. Overload Tr. Rd. 2803 W. 10th St. 213 18th St. 1611 W. Eisenhower Blvd. 1105 South Havana 2880 S. Circle Drive 520 Peterson Road 3851 Hwy. 119 6794 N. Academy Drive 680 E. 84th Avenue 400 E. 104th Ft. Collins 80521 Brighton 80621 Longmont 80501 Loveland 80537 Loveland 80537 Denver 80216 Commerce City 80022 Lakewood 80226 Aurora 80012 Littleton 80123 Littleton 80123 Highland Ranch 80126 Northglenn 80234 Berthoud 80513 Boulder 80301 Broomfield 80020 Thornton 80221 Lafayette 80026 Thornton 80223 Golden 80401 Westminster 80020 Lakewood 80226 Niwot 80544 Sterling 80751 Bellvue 80510 LaPorte 80535 Greeley 80631 Greeley 80631 Loveland 80537 Aurora 80012 Colorado Springs 80906 Colorado Springs 80915 Longmont 80501 Colorado Springs 80918 Thornton 80221 Thornton 80229 940760 CONO SERVICES INC P.O. Box 4784 - TR 3038, Houston, TX 77210-4784 73-1143039 STORE NO. ADDRESS CITY ZIP Colorado (continued) *06406 *06407 *06408 *06409 *06410 *06411 *06412 *06414 *06415 *06416 *06417 *06418 *06419 *06421 *06422 *06423 *06424 *06426 *06428 *06429 *06430 *06431 *06432 *06433 *06434 *06436 *06440 *beer only rev 9/93 1090 S. Havana 303 S. Colorado Blvd. 2110 S. Federal 14401 E. 6th Ave. 3000 28th St. 600 S. Broadway 525 U.S. Hwy. 287 330 S. Academy Blvd. 507 Garden of the Gods 515 N. Murray Blvd. 911 S. Circle Drive 3495 S. Monaco Pkwy. 500 W. 120th Avenue 2100 S. Monaco Pkwy. 785 Colorado Blvd. 4785 Federal Blvd. 8900 E. Hampden 5096 S. Yosemite 5898 S. Broadway 160 W. 104th 7995 N. Federal Blvd. 4750 Kipling Street 12085 E. Colfax Ave. 5500 E. Arapahoe 1003 N. Academy Blvd. 3700 N. Freeway 1013 cENTRE sT. Aurora Denver Denver Aurora Boulder Boulder Broomfield Colorado Springs Colorado Springs Colorado Springs Colorado Springs Denver North Glenn Denver Denver Denver Denver Greenwood Littleton North Glenn Westminister Wheat Ridge Aurora Boulder Colorado Springs Pueblo Ft. Collins 80012 80222 80219 80011 80301 80301 80020 80907 80907 80915 80910 80207 80234 80207 80211 80211 80231 Village 80111 80121 80234 80030 80034 80010 80303 80909 81008 80525 940760 Werner R. Kraatz Coordinator Jobber Programs Date: Dear \,,1^l_D CC 1S 1TY Conoco Inc. . iL�2 P.O. Box 4784 �., _,. Houston, TX 77210 1713) 293-27101 I;, I I Mil: u0 CLERK TO THE LO;°'TTD Enclosed you will find the application for the renewal of the �S license for: , Coti1/4 O -w *' et 3 and payment in the amount of licensing fees. it>i i.i f et for the Please return the 1993 license(s) to my attention at P. D. Box 4784, TR3032, Houston, TX 77210-4784. If you have any questions regarding the information submitted, please contact me at 713-293-2740. Sincerely, Werner Kraatz 940760 DATE: JULY 14, 1994 TO: ROSEMARY LOPER, RECORDS FROM: OFFICE OF WELD COUNTY CLERK TO THE BOARD SUBJECT: LIQUOR LICENSE CHECKS Please run a records check on the following establishment. This information will be used by the Board of County Commissioners in considering renewal of liquor license. Please respond no later than JULY 21, 1994. Thank you. ESTABLISHMENT: CONO-SERVICES, INC., dba CONOCO #06355 12435 WELD COUNTY ROAD 2 BRIGHTON, CO INCLUSIVE DATES: August 1993 through July 1994 BY: Shelly K. Miller, Deputy Call 356-4000, ext. 4226 WHEN COMPLETED, OR IF QUESTIONS. No violations on record. BY C 7 G210..tiY VIOLATIONS: (PLEASE LIST ) (nnly rnpnrfa nn filnwenn thafta) BY: 940760 vetZmw COLORADO mEmORAil Dum To Prom subict: WELD CCU;:TY CC.',..�� z -C CRS CJ. Board of County Commissio%e s rrgTudy Keith A. Schuett, Current Planner II Liquor license renewal FRK THE CC:' --.7,D Cono-Services, Inc., dba, Conoco #06355, 12435 Weld County Road 2, Brighton, Colorado, on property described as part of the S2 of Section 31, TIN, R66W of the 6th P.M., Weld County, Colorado, (Parcel #147131000009) is a legal use in the C-3 (Commercial) zone district of Weld County. 940760 (conoco) No. 015570 38 em KAYO OIL COMPANY PONCA CITY, OK 74602 To:... First National Hank' and Trust Co. Ponca City, Oklahoma *** VOID AFTER 90 DAYS Mx* JUNE 22, 1994 Vendor Code: 008765R11 Exactly xxxxxx**********592.50x* Pay To the Order' ` Of "I COLORADO DEPT OF REVENUE LIQUOR ENFORCEMENT DIVISION STATE CAPITOL ANNEX 1375 SHERMAN ST DENVER CO 80203 11111,11 I III 111111.11 11111 11111111111111111111111 COLORADO DEPARTMENT. OF REVENUE LIQUOR`:LICENSING. DIVISION 1375 SHERMAN'-,ST DENVER CO 80203-2246 ' rg AuthorizedSignature 00 387 472 538 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) PS Form 3800, June 1985 Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Dale Delivered Return Receipt showing to whom, Date. and Address of Delivery TOTAL Postage and Fees S Postmark or Date / /(//��//J / ./2-`m /�q 0 0 x m ≥ c A V o `o o a- N_ 3 E o O1 x C O _ w 0 ❑ Addressee's Address 0 0 U 0 cc It postmaster for fee. E N N C U °' onal services. a « « 9 7 oao>`o reverse of this form so 0 o x 5 O C y o U 0 O a o 0 u g a t E 0 w Q v T m a m U t - w E'Et = 0 inw 0 x ¢ U w a❑❑ 0 C r a C O co 9 — Q m wa N co w v a N 'Op •o( m W 0 H 2 W aa y o c. a ` N 2 w' 2 N 5 r O E 0 a a�'w o w c a+ `m ¢ O w z E+ o a o(p0«O.4 W N N di m« c v -P! Uw' 0 N N 0 C C0 d' • :', Wp O H f+ EE5o7Et 2 w w'o :: d "c; -7, E -0 o w c w ci m o ° d IZ O W W Waa�' uw mu 00 F 1n 5 wit! : • .a O'6 2 Won .2.2H m Signature (Add C cr .�. rn ro d W z cc I- F W U W 2 O O 0 0 0 LL a 940760 '.O 1989-230-555 PS Form 3800, June 1985 P 387 472 548 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) Sent to Street and No CONO—SERVICES, INC. DBA CONOCO #06355 12435 WCR 2 BRIGHTON, CO 80601 Restricted Delivery Fee Return Receipt showing to whom and Date Delivered Return Receipt showing to whom. Date and Address of Delivery TOTAL Postage and Fees S Postmark or Date S--/( co to L ▪ N o a, m m J C E u Q W o m o o y o d L '` •O 3 N Q o ° ❑ To 0 O O " O a) 0 ai 0 a as o oE ¢ c c c ❑ ❑ ❑ N N C Z ~ E a' VdE „Jl M ] y o Q� N¢ U w E s m m o [ c a O O o vi t a) a) `o a w . w .2 O O co `o m 0 0 E E a) v mTe ° c « o • : E g ._ a) a) a « « E. c o w E .6 L O , O 0 2 0 O f; O :6( a 9 o.E r o .O 0 N N ¢ c m o L a a o F) m1:31) 00 o a CL pim .- « c m w mE EE¢ E E E o `o o c EI • «c`-s�tED 0 c c 0 Y N j C .L U¢ C 0 (C O0?(OJL DO.- a) w OEEC3 - «.E wo o Qtr>)0 « 0 -Fs M e'❑'a❑ to cr m O • U O z o i.o H to O (os)0 co COtip O C W O H O N U 2 2 U3 0 to O F I U ul z o zz ¢ c H O - m W U W z W U I— CW C 0 G a 940760 Hello