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G�c, M - 19�2 a�r5 <br />Cer�i Fi c_c1 Ma " I - SG 1nLom�Ie� <br />• Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />• Print your name and address on the reverse <br />so that we can return the card to you. <br />• Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />Mr. Laurens W. Leffingwell, Jr. <br />Gold Basin Mine, LLC <br />c/o Simpson Estates, Inc. <br />30 N. La Salle St., Ste 1232 <br />Chicago, 11 60602 <br />A. Si ature <br />/- /J <br />X <br />❑ Agent <br />JI l t <br />Addr ee <br />B. by (Punted` Name) <br />'' <br />a e of D ive <br />[Reeceived <br />D. Is delivery address different from item 1? <br />Yes <br />If YES, enter delivery address below: <br />0 No <br />3. Service Type <br />❑ Certified Mall ❑ Express Mail <br />❑ Registered ❑ Retum Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) <br />n V- <br />2. Article Number <br />(transfer from service iaaef) 7 012 3 4 6 0 0 0 0 0 6 3 8 4 5 3 6 8 <br />PS Form 3811, February 2004 Domestic Return Receipt -- 102595- 02- M.�sgc <br />Postal <br />CERTIFIED <br />MW'- ECEIPT <br />co <br />'' <br />only; <br />rn <br />Ln <br />7— <br />CO <br />M <br />`0 <br />Postage: <br />C3 <br />Certified Fee: $1.72 <br />0 <br />C3 <br />(Endorsem <br />Return Receipt Fee: $3.10 <br />$2:55 <br />Restricter <br />E3 <br />(Endorserr <br />Total Postage & Fees: <br />$7.37 <br />"" <br />M <br />Total Postage <br />& Fees I $ 1 <br />Mr. Laurens W. Leffingwell, Jr. <br />ru <br />ra <br />Gold Basin Mine, LLC <br />L <br />c/o Simpson Estates, Inc. <br />30 N. La Salle St., Ste 1232 --------------- - <br />Chicago, 1160602 bee Aeverse for Instruction,.— <br />