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Donald J. Self, Double Eagle Claim application <br />Item I and J. <br />CERTIFIED MAIL`''' RECEIPT <br />nJ Domestic Mail Only <br />rU For delivery informationvisit our website at www.usps.corn <br />wall C PK L <br />VI Certified Mail Fee <br />0054N345 <br />Extra Services 8 Fees( ,add feel) 06 <br />D Return Receipt( colc) $ $0.00 <br />O Return Receipt(electronic) $ $0.00 PO°tm°rk <br />0 0 Certified Mail Reetncted Delivery $ an <br />I. <br />net <br />4 <br />Here <br />i0 0 Adult Signature Required i JV <br />0 Adult Signature Restricted Delivery$ $0 00 <br />O Postage <br />s 0.71 s <br />Total Postage and Fees 01/27/2016 <br />s 6.96 <br />ul Sent To <br />ri r"7:, (AJ. . 1 i(4 rn - T'((ev Cc. + <br />O - treet and Apt.No.,or PO Box No. t1N (20 ..„°-,L).‘- ( Y' <br />City,State,Z +d•r <br />i Lev4ii ( Ai (U <br />PS Form 3800,April 2015 PSN 7,3u-o2-oou-9c4I See Reverse for Instructions <br />Receipt for mailing of DRMS application with needed paperwork to the Teller <br />County Commissioner's. <br />U.S. Postal Service'" <br />CERTIFIED MAIL® RECEIPT <br />Domestic Mail Only <br />ru For delivery information,visit our website at www.usps.com <br />CRIPPLE CREEK, CO 30$13 t ; <br />ui F $3.45 0054 <br />e - `Extra Se's ces 8 Fees tench boa,add feel ate) <br />06 <br />Re,,.r"Receipt eiarcicepyi $ <br />0yN <br />O <br />Return Receipt ieiectroreci $ $u.QV P Yrtark <br />J Canoed Mae Rest-iced Delivery $ $0.00 Wore <br />r 0 E Adult Signature Required $ $o.00bill <br />J Adult Stg'tature Restncted Delivery$ <br />VV LL V <br />v <br />O hostage <br />4.71 <br />e <br />i <br />1! - ITotal Postage and F 01/202016 <br />S <br />6.96 <br />I l ;Sent Tg I / /P r- tePtr L.l.t_-{-,/7 C (e`'L. <br />4 0 ; treettdApt.No.,or Itt 8*Fio <br />t e• ' 6-rC <br />Crty,$ate,ZIPS 3 <br />f' . CO(5'O l <br />PS Form 38Uu,April 2015 PSN 7 3o n,-u,lo-go47 See Reverse for Instructions <br />Receipt of mailing of DRMS application to Teller County Recorder.