2015-03-16_GENERAL DOCUMENTS - M1987116

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DELIVERY SECTIONSENDER:COMPLETE THIS ■ Complete items 1,2,and 3.Also complete A. n ure item 4 if Restricted Delivery is desired. x ❑Agent ■ Print your name and address on the reverse ❑Addressee { so that we can return the card to you. B. Re Ived b int d Name) C. Date of Delivery j ■ Attach this card to the back of the mailpiece, / � � � or on the front if space permits. d I 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes i If YES,enter delivery address below: ❑No I Mr. Joe Smith High Country Bank 7360 W. HWY 50 3. Service Type Salida, CO 81201 ❑Certified Mail" ❑Priority Mail Express'" ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7014 2120 0001 7871 1752 (transfer from service label) PS Form 3811,July 2013 UNITED STATES 11;aSiFAb WRVICE First-Class Mail +:.X2: AZI Postage&Fees Paid USPS Certified Mail service provides the following benefits: & Permit No.G-10 ■A Certified Mail receipt( lion of the mailpiece;include applicable postage to Certified Mail label). cover the return receipt service fee;and ■Aunique ide'"�y'g Uou(i aQ�e. 'W endorse the mail iece"Return Receipt 0 Sender: Please print your name, address, and ZIP+4®in this box' •Electronic verific5lion of celivery or attempt e r s e a retail associate for delivery. //�� ? assistance.For an electronic return receipt, ■A record of de (4luA tiler gieht's see a retail associate for assistance.To signature)that is retained-ffiePo areeeive a dtivI rat return receipt,present Service®for a specified period. this USPS®-postmarked Certified Mail State of Colorado Important Reminders. receipt to the retail associate,who will ■You may purchase Certified Mail service with Provide a duplicate return receipt for no Department of Natural Resources First-Class Mail®,First-Class Package additional tee. Service®,or Priority Mail*service. Restricted delivery service,which provides Division of Reclamation, Mining 8t Safety ■Certified Mail service is not available for delivery to the addressee specified by name, international ser. or to the addressee's authorized agent. 1313 Sherman Street, Suite 215 Include applicable postage to cover the ■Insurance coverage is notavailable for restricted delivery fee and endorse the Denver, CO 80203 Spec TOO purchase with Certified Mail service.However, mailpiece"Restricted Delivery,"or see a the purchase of Certified Mail service does not retail associate for assistance. File change the insurance coverage automatically ■To ensure that your Certified Mail receipt is included with certain Priority Mail items. accepted as legal proof of mailing,it should ■For an additional fee,you may request the bear a USPS postmark.If you would like a following services: postmark on this Certified Mail receipt,please -Return receipt service,w ' rp a ypu presen_tyoaur C fied Mail item ate Post with a record of delivery kABifl tt 313 SU t�rilo R ing.If you don't need a recipient's signature).YogXan�re�qquesta f��o��1t/��aa((kon this Certified Mail receipt,detach WJ 'lN'l'Ial'�Iillll�l'ill"II�'I'llll"�Illl"��ii'll�'il'i111�riij hardcopy return receipt&MFIkFycCo 8vrsldikoded portion of this label,affix it to the version.For a hardcopy r rn rer4i 'I ' apply appropriate postage,and complete PS Form F381 orm �e mailpiece. Receipt attach PS Form -SM this receipt for your records. PS Form 3800,July 2014(Reverse)PSN 7530-02-000-9047 U.S. Postal Servic�e • , G1 RECEIPT rU Domestic Mail Only rn Ln Ll Co Postage $ Certified Fee 0 Return Recelpt Fee p (Endorsement Required) Q • d Restricted Delivery Fee N O (Endorsement Required)ru Total Postage&Fees $ - � JAY ru —gent To � Mr. Joe Smith or PO Box No. High Country Bank � --:------------------ City,state ZIP+4 7360 W. Hwy 50 ---------------------- Salida, CO 81201