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3I- � <br />AML <br />M Ig92 -d�5 <br />Ce-4 Sfe-8 Mall) - 1 ruC 50 <br />• Complete items 1, 2, and 3. Also complete A. ig atu e <br />item 4 if Restricted Delivery is desired. <br />• Print your name and address on the reverse Er Agent <br />so that we can return the card to you. 0 Addre <br />• Attach this card to the back of the mailpiece, Received by ( Name) C.�aYeof kli <br />or on the front if space permits. /�� <br />1. Article Addressed to: <br />Mr. -Laurens W. Leffingwell, Jr., <br />Gol Basin Mine, LLC <br />c/o Simpson Estates, Inc. <br />30 N. La Salle St., Ste 1232 <br />Chicago, 11 60602 <br />D. Is delivery address different from item 1? O Yes <br />If YES, enter delivery address below: ❑ No <br />3. oervlce type <br />Or Certified Mail ❑ Express Mail <br />13 Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mall ❑ C.O.D. <br />6- RPetr M-4 171.a:........n <br />r. nrncre rfrom service label) 7012 3460 0000 6384 7898 <br />Transfer from l) <br />PS Form 3811, February 2004 Domestic Return Receipt <br />102595 -02 -M -1540 <br />Postal <br />TM <br />CERTIFIED MAILT- RECEIPT <br />p� D' Only; <br />Cc 0 <br />Postage: <br />rrr Certified Fee: $0.69 <br />-� $3.30 <br />Return Receipt Fee: <br />c $2.70 <br />� <br />�Q•tiere Total Postage & Fees: �'` Here k , 'S' <br />G �= � , <br />O (Endorsement Required) <br />t- <br />..n j - <br />? Total Postage & Fees 1 <br />M <br />S Mr. Laurens W. Leffin Jr. a Gold Basin Mine, LLC = 3o �� c/o Simpson Estates, Inc. <br />30 N. La Salle St., Ste 1232 ----- ------ - <br />Chicago, <br />1160602 <br />