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OF COLOZADO <br />%clamation, Mining and Safety <br /> if Natural Resources <br />,n Street, Room 215 <br /> rado 80203-2273 <br /> Broken Arrow Investments LLC <br /> Doug Derr <br /> 801 8th St., Ste 130 <br /> Greeley, CO 80631-3903 <br /> COMPLETE THIS SECTION ON DELIVERY <br /> SENDER: COMPLETE THIS SECTION =i -— <br /> ■ Complete items 1,2,and 3.Also complete <br /> A. Signature 0 Agent <br /> item 4 if Restricted Delivery is desired. X ❑Addressee <br /> ■ Print your name and address on the reverse C. Date of Delivery <br /> so that we can return the card to you. B. Received by(Printed Name) <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. D. Is delivery address different from item 1? ❑Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑ No <br /> Broken Arrow Investments LLC <br /> Doug Derr <br /> 801 8th St.,Ste 130 <br /> Greeley, CO 80631-3903 73. Service <br /> 0 Priority Mail Express❑ Return Receipt for Merchandise <br /> ❑Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7 014 0150 0000 9138 3835 <br /> (Transfer from service label) <br /> Return Receipt R e <br /> PS Form 3811,July 2013 Domestic - <br /> II.S. Postal <br /> ` CERTIFIED MAIL, RECEIPT <br /> M n m <br /> (DomesticOnly; .• Provided) <br /> ®_ ra m For delivery information visit our website at www.usps.com <br /> CO -o L OFFICIAL USE <br /> m m <br /> ® a r-q Pogsy $ <br /> Ir a- <br /> Certified Fee <br /> _ ® o o IPo.;lnedc <br /> CI 0 Return Receipt Fee Hem <br /> ® O r_3 (Endorsement Required) <br /> ® Restricted Dellvery Fee <br /> ® C3 M (Endorsement Required) <br /> Ll ul <br /> r-R r-9 Total Postage&Fees $ <br /> o� 0 C3 <br /> _ Broken Arrow Investments LLC ..._. <br /> ® p C3 3`hwt—AR)W; Doug Derr <br /> .............. <br /> r� r` or PO Box No. _ 801 8th St T Ste 130 <br /> t ii;State,ZIF _ Greeley,CO 80631-3903 <br /> PS Form :r0 August 2006 See Reverse for Instructions <br />