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Home My WebLink About20163728.tiffRESOLUTION RE: APPROVE PETITION FOR ABATEMENT OR REFUND OF TAXES - FAIRWAY ACRES, INC. 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, the Board of County Commissioners of Weld County, State of Colorado, at a duly and lawfully called regular meeting held on the 12th day of December, 2016, at which meeting there were present the following members: Chair Mike Freeman, and Commissioners Sean P. Conway, Julie A. Cozad, and Steve Moreno, with Commissioner Barbara Kirkmeyer being excused, and WHEREAS, notice of such meeting and an opportunity to be present has been given to the taxpayer and the Assessor of said County, with said Assessor, Christopher Woodruff, being present, and taxpayer, Fairway Acres, Inc., not being present, and WHEREAS, the Board of County Commissioners has carefully considered the attached petition, and is fully advised in relation thereto. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Board concurs with the recommendation of the Assessor and the petition be and hereby is, approved, and an abatement or refund be allowed as follows: CORRECTION TO VALUATION ASSESSED ABATEMENT OR REFUND YEAR TAX $333,500.00 $14,887.67 2015 cc.: oept. I CA,PPL. af., GaritCrH), cx.sRCcw/oic<ca.) 01/talit -7 2016-3728 AS0093 TAX ABATEMENT PETITION - FAIRWAY ACRES, INC. PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 12th day of December, A.D., 2016. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: ddriwt) &C'vi Weld County Clerk to the Board BY: O oun y Attorney \� Date of signature: trOr/1 Co puty Clerk to the Board Mike Freeman, Chair Sean P. Conway, Pro-Tem Julie A. Cozad AS TO CUSED rbara Kirkmeyer Steve Moreno 2016-3728 AS0093 R tit CO ( County WELD PETITION FOR ABATEMENT OR REFUND OF TAXERECEIVED Date Received Section 1: Petitioner, please complete Section I only. Date: September 20 2016 MownDay Year Petitioners Name Fairway Acres Inc (Use Assessor's or Commissicners' tamp) 2 3 2016 WELD COUNTY ASSESSOR GRFILtI', COLORADO Petitioners Mailing Address 1050 East CR 76 Wellington CO 80549 C rty or Town SCHEDULE OR PARCEL NUMBER(S) R4504806 State Zip Code CEIVED Mir 1 5 2016 PROPERTY ADDRESS OR LEGAL DESCRIPTION OF PROP WLD COUNT'N � Y 2901 Saddler Boulevard, Severance, CO COMM I S �RS Petitioner requests an abatement or refund of the appropriate taxes and states that the taxes assessed against the above property for property tax year(s) 2015 and are incorrect for the following reasons: :Briefly describe why the taxes have been levied erroneously or illegally, whether due to erroneous valuation, irregularity in levying clerical error or overvaluation. Attach additional sheets if necessary.) The valuation for 2016 taxes was protested and settled at $1,150,000 for 2016 (settlement attached). The same valuation circumstances were in place for 2015 and no protest was filed, so reque n be set at $1,150,000 and taxes refunded for the overpayment portion. Petitioner's estimate of value: $ 1,150,000 (2015 Value Year Value Year I declare, under penalty of perjury in the second degree, that this petition, together with any accompanying exhibits or statements, has been prepared or examined by me. and to the best of my knowledge, information and belief, is true. correct, and complete. By f Agent's SI Daytime Phone Number ( Daytime Phone Number ( 970 ) 674-1313 'Letter of agency must be attached when petition Is submitted by an agent. if the Board of County Commissioners, pursuant to ; 39-10-114(1). C.R S , or the Property Tax Administrator, pursuant to § 39-2-116, C.R.S., denies the petition for refund or abatement of taxes in whole or in part, the Petitioner may appeal to the Board of Assessment Appeals pursuant to the provisions of C 39-2.125, C R S .. 'xithin try days of the entry of any such decision, § 39-1O-114.5(1). C.R.S. Section II: Original Corrected Abate/Refund Tax Year Assessor's Recommendation (For Assessor's Use Only) zOJl Tax Year Actual Assessed Tax Actual Assessed Tax S329- a Po 6/, 121. 1,5t o00 3Z3,$ao 570, 3 ail' io 7M40 Istfin,.47 ,Assessor recommends approval as outlined above. If the request for abatement s based upon the grounds of overvaluation, no abatement or refund of taxes shall be made if an objection or protest to such valuation has been filed and a Notice of Determination has been mailed to the taxpayer, § 39-10-114(1)0a)(I)(D), C R S Tax year 2 Q.(5' Protest? No 0 Yes (If a protest was flied, please attach a copy of the NOD.) Tax year: Protest? E No 0 Yes (If a protest was filed please attach a copy of the NOD.) Assessor recommends denial for the following reason(s): 4fi1 r >re VertkJ 0' 41/ ne 4ichef v4-/ie 467 4441jJtf,c,revt w4j Assessor'sor uty Assess. 7` ignz -OPT-AR No 920-66'11 2016-3728 FOR ASSESSORS AND COUNTY COMMISSIONERS USE ONLY (Section III or Section IV must be completed) Every petition for abatement or refund filed pursuant to § 39-10-114, C.R.S. shall be acted upon pursuant to the provisions of this section by the Board of County Commissioners or the Assessor, as appropriate, within six months of the date of filing such petition, § 39-1-113(1.7), C.R.S. Section III: Written Mutual Agreement of Assessor and Petitioner (Only for abatements up to $10,000) The Commissioners of County authorize the Assessor by Resolution No. to review petitions for abatement or refund and to settle by written mutual agreement any such petition for abatement or refund in an amount of $10,000 or less per tract, parcel, or lot of land or per schedule of personal property, in accordance with § 39-1-113(1.5), C.R.S. The Assessor and Petitioner mutually agree to the values and tax abatement/refund of: Original Corrected Abate/Refund Tax Year Tax Year Actual Assessed Tax Actual Assessed Tax Note: The total tax amount does not include accrued interest, penalties, and fees associated with late and/or delinquent tax payments, if applicable. Please contact the County Treasurer for full payment information. Petitioner's Signature Date Assessor's or Deputy Assessor's Signature Date Section IV: Decision of the County Commissioners (Must be completed if Section III does not apply) WHEREAS, the County Commissioners of County, State of Colorado, at a duly and lawfully called regular meeting held on I I , at which meeting there were present the following members: Month Day Year with notice of such meeting and an opportunity to be present having been given to the Petitioner and the Assessor of said County and Assessor (being present --not present) and Name Petitioner (being present --not present), and WHEREAS, the said Name County Commissioners have carefully considered the within petition, and are fully advised in relation thereto, NOW BE IT RESOLVED, that the Board (agrees --does not agree) with the recommendation of the Assessor and the petition be (approved --approved in part --denied) with an abatement/refund as follows: Year Assessed Value Taxes Abate/Refund Year Assessed Value Taxes Abate/Refund Chairperson of the Board of County Commissioners' Signature l County Clerk and Ex -officio Clerk of the Board of County Commissioners in and for the aforementioned county, do hereby certify that the above and foregoing order is truly copied from the record of the proceedings of the Board of County Commissioners. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said County this day of Month Year County Clerk's or Deputy County Clerk's Signature Note' Abatements greater than $10,000 per schedule, per year, must be submitted in duplicate to the Property Tax Administrator for review. Section V: Action of the Property Tax Administrator (For all abatements greater than $10,000) Th:'action of the Board of County Commissioners, relative to this abatement 1. petition, iss hereby pproved Approved in p $ k8Z'7 � • 401 �-�D- nied foterie follow ason(s 15-DPT-AR •. •20-66/11 LIMITED POWER OF ATTORNEY 1/We, Fairway Acres Inc and Windsong Estate, whose address is CO , (the "Principal") do hereby designate DRM Real Estate Advisors. LLC, whose address is 700 Automation Drive Unit G-200, Windsor, CO 80550, (the "Agent") as my/our attorney -in - fact and agent for the limited purpose set forth herein: TO ACT ON PRINCIPAL'S BEHALF AND IN PRINCIPAL'S NAME IN THE FILING AND PURSUIT OF PROTESTS AND/OR APPEALS OF THE COUNTY ASSESSOR'S VALUATION(S) FOR THE PROPERTY/PROPERTIES LISTED BELOW, TO ADVOCATE FOR AND AGREE TO A REVISED VALUATION FOR SAID PROPERTY/PROPERTIES AND, IF APPROPRIATE, TO PURSUE ABATEMENT OF TAXES PAID BY PRINCIPAL IN PREVIOUS YEARS FOR SAID PROPERTY/PROPERTIES. This Power of Attorney applies to assessments for the following parcel number(s): 2901 Saddler Boulevard, Severance CO PIN 070509301075 Principal hereby grants Agent full power and authority to do everything necessary in exercising the powers herein granted as fully as Principal might or could do personally, with full power of substitution or revocation hereby ratifying and confirming all that Agent shall lawfully do or cause to be done by virtue of this power of attorney and the powers herein granted. This Limited Power of Attorney shall not be affected by Principal's disability or by the dissolution of Principal as an entity. This Limited Power of Attorney shall expire December 31, 2016, IN WITNESS WHEREOF, Principal has executed this Limited Power of Attorney this 'I' day of ,2016. 6 Principal STATE OF COLORADO COUNTY OF LI2AAPV\e{ ) ss. The forgoing Limited Power of Attorney was acknowledged before me this "1 day of I►'l ,20 c ,by i< en), fr u&acoJ Witness my hand and official Seal: My Commission Expires: ID, 2016'1 Notary P is JENNIFER CZAPIEWSK1 NOTARY PueL C: STATE OF COLORADO NOTARY ID 20074015358 MY COMMISSION EXPIRES APR 16, 2019 COUNTY BOARD OF F,QUALIZATION WELT) COUNTY Single County Schedule Number R4504806 STIPULATION (As To Tax Year 2016_ Actual Value) RE PETITION OF : Windsong Estate Event Center NAME: Fairway Acres Inc ADDRESS: 1050 C. County Road 76 Wellington, CO Petitioner (s) and the Weld County Assessor hereby enter into this Stipulation regarding the tax year 2016 valuation of' the subject property, and jointly move the Board of Equalization to enter its order based on this Stipulation. Petitioner (s) and Assessor agree and stipulate as follows: 1. The property subject to this Stipulation is described as: SEl' SP TRACT 1 SADDLER PUD 2. The subject property is classified as Commercial property. 3. The County Assessor originally assigned the following actual value to the subject property for the tax year 2016: Total $1,520:324.00 4. After further review and negotiation, Petitioner (s) and Weld County Assessor agree to the following tax year 2016 actual value for the subject property: Total $1,150,000.00 5. The valuation, as established above, shall be binding only with respect to tax year 2016. 6. Brief narrative as to why the reduction was made: Analysis of actual income in base period as well as sales of other event centers. 7. Both parties agree that: zrl%hc hearing scheduled before the Board of Equalization on 08/04'2016 at 10:00 a.m. be vacated. A hearing has not yet been scheduled before the Board of Equalization. R4504806 1 D&TEDi zy of July, 2016. Aget#i#�or`Attorney Address: ORM RAC. E5721 i E ADVl5v8 li,x Telephone: 97Q -c 7y - /313 4' Docket Number Stip-1.Frm R4504806 (Assistant) County Attorney for Respondent, Weld County Board of Commissioners Address: 1.L' 1150 "O" Street P.O. Box 758 Greeley, CO 80632 Telephone:(970) 336-7235 9 22/11Ako. County As ssor Address: 1400 N.17th Avenue Greeley, CO 80631 Telephone: (970) 353-3845 ext. 3697 I Weld County Treasurer Account R4504806 Parcel Number Receipt Date 070509301075 Aug 3.1.2016 FAIRWAY ACRES INC 1050 E COUNTY ROAD 76 WELLINGTON. CO 80549-2011 Situs Address Payor 2901 SADDLER BLVD SEVERANCE. 000000000 Legal Description SEV SP TRACT I SADDLER PUD Property Code SPEC.PURPOSE-LAND - 2130 RECREATION -IMPROVEMENTS - 2225 Payments Received Credit Card Payments Applied Year Charges 2015 Rehilling Fee 2015 Interest 2015 Tax Billed $5.00 $916.82 $61.121.44 Receipt Number 2016-08-31-04-8596 C.'ONNIE MATSIJDA 2901 SADDLER BLVD I ORT COLLINS. CO 80524 Actual 261.360 1,258,964 Assessed 75.790 365.100 Prior Payments $5.00 $916.82 $55.638.90 Year 2015 2015 $5.482.54 Area 3953 3053 New Payments $0.00 $0.00 $5.482.54 Mill Levy 138.632 138.632 Balance $0.00 $0.00 $0.00 $5.482.54 Balance Due as of Aug 31, 2016 "Thank you lbr your payment all payments subject to final hank clearance 50.00 $0.00 Property Report Page 1 of 6 WELD COUNTY Property Report P RO P E RTY PORTAL Technical Support: (970) 400-2500 Account: R4504806 November 16, 2016 Account Information Account Parcel Space Account Type Tax Year Buildings Actual Value Assessed Value R4504806 070509301075 Commercial 2016 1 1,150,000 333,500 Legal SEV SP TRACT 1 SADDLER PUD Subdivision Block SADDLER PUD Lot Land Economic Area SADDLER PUD Property Address Property City Zip Section Township Range 2901 SADDLER BLVD SEVERANCE 09 07 67 Owner(s) Account Owner Name Address R4504806 FAIRWAY ACRES INC 1050 E COUNTY ROAD 76 WELLINGTON, CO 805492011 Document History https://propertyreport.co.weld.co.us/?account=R4504806 11/16/2016 Property Report Page 2 of 6 Reception Rec Date Type Grantor Grantee Doc Fee Sale Date Sale Price 3409109 SUB SUBDIVISION PUDDLER 0.00 0 3474569 05-09-2007 WD BRIDLE HILL DEVELOPMENT CO LLC FAIRWAY ACRES INC 32.32 08-04-2006 323,200 Building Information AccountNo R4504806 Building 1 Building ID 1 Occupancy Clubhouse ID Type NBHD Occupancy Complete Bedrooms Baths Rooms 1 Commercial 2911 Clubhouse 100 0 0 0 ID Exterior Roof Cover 1 Interior HVAC Gable Perimeter Units Unit Type Complete HVAC 400 Make 0 ID Square Ft Condo SF Total Basement SF 1 8,152 0 0 Finished Basement SF 0 Built As Details for Building 1 Garage Carport Balcony Porch SF SF SF SF 0 0 ID Built As 0 0 Square Ft Year Built Stories Length Width 1.00 Clubhouse 8,152 2013 1 0 0 https://propertyreport.co.weld.co.us/?account=R4504806 11/16/2016 Property Report Page 3 of 6 Additional Details for Building 1 ID Detail Type Description Units 1 Mezzanine Office 1,386 1 Add On Corn Canopies Steel Good 1,056 1 Add On Asphalt Average 20,000 1 Add On Concrete Slab Average 2,500 Valuation Information Type Code Description Actual Value Assessed Value Acres Land SqFt Improvement 2225 RECREATION- IMPROVEMENTS 888,640 257,710 0.000 0 Land 2130 SPECIAL PURPOSE -LAND 261,360 75,790 2.000 87,120 Totals - - 1,150,000 333,500 2.000 87,120 Tax Authorities https://propertyreport.co.weld.co.us/`?account=R4504806 11/16/2016 Property Report Page 4 of 6 Tax Area District ID District Name Current Mill Levy 3953 0700 AIMS JUNIOR COLLEGE 6.325 3953 1051 CLEARVIEW LIBRARY 3.583 3953 1206 FORT COLLINS CONSERVATION 0.000 3953 0304 NORTH WELD COUNTY WATER (NWC) 0.000 3953 0301 NORTHERN COLORADO WATER (NCW) 1.000 3953 1346 SADDLER RIDGE METRO 50.000 3953 0204 SCHOOL DIST RE4-WINDSOR 41.494 3953 0427 SEVERANCE TOWN 12.635 3953 0100 WELD COUNTY 15.800 3953 0521 WINDSOR -SEVERANCE FIRE 7.248 3953 0533 WINDSOR -SEVERANCE FIRE (BOND 2023) 0.547 Total - - 138.632 Photo https://propertyreport.co.weld.co.us/?account=R4504806 11/16/2016 Property Report Page 5 of 6 Sketch https://propertyreport.co.weld.co.us/?account=R4504806 11/16/2016 Property Report Page 6 of 6 N N 63' v U w O Bath Bride's Room 1386.0 sf Mezzanine Sketch b, Ao.0 Sk«N, 44' Building 1 Page 1 40' 44' First Floor 8152.0 sf WH 23' Built 2013 Copyright © 2016 Weld County, Colorado. All rights reserved. Privacy Policy & Disclaimer I Accessibility Information https://propertyreport.co.weld.co.us/?account=R4504806 11/16/2016 CLERK TO THE BOARD PHONE: (970) 400-4225 FAX: (970) 336-7233 1150 O STREET P.O. BOX 758 GREELEY, COLORADO 80632 November 16, 2016 Fairway Acres, Inc Windsong Estate Event Center Attn: Kenji Matsuda 1050 East CR 76 Wellington, CO 80549 RE: SCHEDULE NUMBER 070509301075, R4504806 Dear Property Owner: This is to advise you that the Weld County Board of Commissioners will hear your petition for abatement or refund of taxes on the property described as: Fairway Acres, Inc., dba Windsong Estate Event Center, at 2901 Saddler Boulevard, Severance, CO 80524. The meeting is scheduled for December 12, 2016, at 9:00 a.m., in the Chambers of the Board of County Commissioners of Weld County, Colorado, Weld County Administration Building, 1150 O Street, Assembly Room, Greeley, Colorado 80631. The Assessor is recommending that the Board approve your petition. You are not required to be present at this hearing; however, this is your opportunity to have your position heard, particularly if your position is opposed to the Assessor's recommendation. If you intend to submit any documentation in support of your position for this hearing, all such documentation must be submitted to the Office of the Clerk to the Board and to the Weld County Assessor's Office at least seven calendar days prior to the meeting date in order for it to be considered at the scheduled hearing. If you have any questions concerning this matter, please do not hesitate to contact me at (970) 400-4225. Sincerely, a, R,,,,AIL Chloe A. Rempel Deputy Clerk to the Board cc: Assessor County Attorney — Frank Haug DRM Real Estate Advisors, LLC — Chris Ruff i PETITIONER, TAX AGENT REPRESENTATIVE, LESSEE POSTAL CODE 80549 80550 CERTIFICATE OF MAILING I hereby certify that I have placed a true and correct copy of the surronding property owners in accordance with the notification requirements of Weld County in the United States Mail, postage prepaid First Class Mail by letter as addressed on the attached list this 16th day of November 2016. Dated the 16th day of November 2016. n ., STATE CO 0 v CITY Wellington L O ti c ADDRESS 1 1050 East CR 76 700 Automation Dr. Unit G-200 COMPANY Fairway Acres, INC, dba Windsong Estate Event Center DRM Real Estate Advisors, LLC LAST NAME Matsuda t cc FIRST NAME Kenji Chris ru m N El N O U.S. Postal Service"' CERTIFIED MAIL® RECEIPT Domestic Mail Only For delivery information, visit our website at www.usps.com''. Certified Mail Fee $nia, Extra Services & Fees (check box, add fee as appropriate) ❑ Return Receipt (hardcopy) $ ❑ Return Receipt (electronic) $ ❑ Certified Mail Restricted Delivery $ Adult Signature Required $ ❑ Adult Signature Restricted Delivery $ A Postage $ rl i+ a. Total Postage and Fees $ —p Sent To ,a� lrcv 14it Postmar Here (Acre9 -Mnw. Street and Apt. No., or POox No. r- lO t 54 GR -1 Cc Qty, State, ZIP -4-4® • • PS Form 3800, April 2015 PSN 7530-02-000-9047 See Reverse for Instructions ry -n ru m N O O 0 U.S. Postal Service' CERTIFIED MAIL® RECEIPT Domestic Mail Only For delivery information, visit our website at www.usps.com Certified Mail Fee $ tofo Extra Services & Fees (check box, add fee as appropriate) ❑ Return Receipt (hardcopy) $ ❑ Return Receipt (electronic) $ ❑ Certified Mail Restricted Delivery $ ❑ Adult Signature Required $ ❑ Adult Signature Restricted Delivery $ Postage $ Total Postage and Fees $ l /c Sent To Centel n Ra.o.t 2.,s+A +t Street and Apt. No., or PO Box No. S (EV IG Here CAdvisa rs LLG COQ GZ.c.s {- a tv, .- ; o to O r. G - 0 OO City, State, ZP+44 ► a d • r CO c . o55o PS Form 3800, April 2015 PSN 7530-02-000-9047 See Reverse for Instructions SENDER: COMPLETE THIS SECTION • Complete items 1, 2, and 3. • Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: DR M Rec.t es+o•4 € adv►sors,wL p�++n C loci S Ro rc 1O C5 Ow fomna.4i O r Or. Un i + C9- a00 w&) r.dsor, cO €5os50 I I III IIII im 114111111 111111 u 9590 9402 1714 6053 4701 50 i COMPLETE THIS SECTION ON DELIVERY A. Signature\ X is se r# ❑ Agent ❑ Addressee C. Date of elivery rll D. Is delivery address different from item 1? ❑ es If YES, enter delivery address below: g No 2. Article Number (Transfer from service label) 3. Service Type O Adult Signature O Adult Signature Restricted Delivery re Certified Mail® ❑ Certified Mail Restricted Delivery ❑ Collect on Delivery O Collect on Delivery Restricted Delivery 'c•j Mail 7016 0750 0000 7938 2692 ;Aail Restricted Delivery 0) PS Form 3811, July 2015 PSN 7530-02-000-9053 ❑ Priority Mail Express® ❑ Registered MailTM ❑ Registered Mail Restricted Delivery ❑ Return Receipt for Merchandise ❑ Signature ConfirmationT"" ❑ Signature Confirmation Restricted Delivery Domestic Return Receipt SENDER: COMPLETE THIS SECTION • Complete items 1, 2, and 3. • Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Ras; cctS t�tr,dsan5 £s+a-tt Eve n+ CQn+t- Cc.+4n •. I<itj ► (v\04 S (050 EONS# GR "1C CWeltifl3+or,r CO 'Se105'19 IIIININIII mi i I u 9590 9402 1714 6053 4701 67 i COMPLETE THIS SECTION ON DELIVERY A. Signature X B. Received by (Printed Name) 20 Agent �°`❑ Addressee C. Da of D livery D. Is delivery address different from item 1? O Yes If YES, enter delivery address below: ❑ No 2. Article Number (Transfer from service label) 7016 0750 0000 7938 268 PS Form 3811, July 2015 PSN 7530-02-000-9053 3. Service Type ❑ Adult Signature O Adult Signature Restricted Delivery sir Certified Mail® ❑ Certified Mail Restricted Delivery O Collect on Delivery ❑ Collect on Delivery Restricted Delivery El Insured Mail 5 I it Restricted Delivery J) ❑ Priority Mail Express® ❑ Registered MailTM ❑ Registered Mail Restricted Delivery ❑ Return Receipt for Merchandise ❑ Signature ConfirmationT"" ❑ Signature Confirmation Restricted Delivery Domestic Return Receipt CLERK TO THE BOARD PHONE: (970) 400-4225 FAX: (970) 336-7233 1150 O STREET P.O. BOX 758 GREELEY, COLORADO 80632 January 9, 2017 STATE OF COLORADO DIVISION OF PROPERTY TAXATION 1313 SHERMAN STREET, ROOM 419 DENVER, CO 80203 RE: PETITION FOR ABATEMENT OR REFUND OF TAXES - FAIRWAY ACRES, INC. To Whom It May Concern: Please review the attached documents, which include the original petition, a copy of the petition, two copies of the resolution approved by the Weld County Board of Commissioners, and a copy of the back-up documentation supporting the petition. If you have any questions concerning this matter, please do not hesitate to contact me at (970) 400-4225. Sincerely, Chloe A. Rempel Deputy Clerk to the Board ru C`- C o n 1 u re co • s • S V i r 1 w • To most locations. CD 01 CC t.) O. I/3 X W CC Please print and press hard. 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WOO Certified Mail Fee $ Extra Services & Fees (check box, add fee as appropriate) ❑ Return Receipt (hardcopy) $ ❑ Return Receipt (electronic) $ ❑ Certified Mail Restricted Delivery $ ❑ Adult Signature Required $ ❑ Adult Signature Restricted Delivery $ Postage i ad Total Postage and Fees Postmark Here 01/f1 / (7 Sent To O R0() Rto.i Es+oke Street and Apt. No., or PO Box No. al 0 0 Ow i- a rno•-i o �n City, State, ZIP+4e ct) i not'3o r , CO VO550 odi C Iris PS Form 3800, April 2015 PSN 7530-02-000-9047 See Reverse for Instructions cc m cc cc N a O a a a N O r -R O U.S. Postal ServiceTM CERTIFIED MAIL° RECEIPT Domestic Mail Only For delivery information, visit our website at www.usps.com'�' Certified Mail Fee $ /A -- Extra Services & Fees (check box, add fee as appropriate) ❑ Return Receipt (hardcopy) $ t ❑ Return Receipt (electronic) $ o Certified Mail Restricted Delivery $ ❑ Adult Signature Required $ ❑ Adult Signature Restricted Delivery $ Postage $ Ota Total Postage and Fees $ 1n /at Postmark Here Olin( Sent To Street and Apt. No., or P t0;94 a a City, State, (A)VGn a; r cou0c-re _'_ciccni .ks, e ox No. GR 1Go to n i co ace49' N 9' PS Form 3800, April 2015 PSN 7530-02-000-9047 See Reverse for Instructions Hello