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M_iq92 -645 <br />Cer�i -�i ec� <br />Ha'I- So APP Correc4- <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 />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. Sig re <br />0 Agent <br />X <br />p Addressee <br />Received byLrinted Nam <br />C D <br />e f eli ery <br />4 <br />I� GO <br />/ <br />D. Is delivery address different from item 1? <br />❑ Yes <br />If YES, enter delivery address below: <br />❑ No <br />3. Service Type <br />0 Certified Mail 0 Express Mail <br />0 Registered 0 Return Receipt for Merchandise <br />0 insured Mail 0 C.O.D. <br />4. Restricted Delivery? (Extra Fee) 0 Yes <br />2. Article Number 7012 3466 6666 6384 5788 <br />(Transfer from service labeq <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />Postal <br />CERTIFIED M AILT. . RECEIPT <br />Co (Domestic <br />CID <br />= Postage: $0.90 <br />CO Certified Fee: $3.30 <br />`0 Return Receipt Fee: $2.70 <br />0 <br />O (Endor t otal Postage & Fees: $6.90 <br />C3 Restr <br />C3 (Endorsement Required) <br />,I- Total Postage & Fees $ <br />M <br />Sent To Mr. Laurens W. Leffingwell, Jr. <br />� Gold Basin Mine, LLC <br />Street, . <br />or POE c/o Simpson Estates, Inc. -------------------- <br />ciry S& 30 N. La Salle St., Ste 1232 <br />Chicago, 116060 2 <br />