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OF COLORADO <br /> eclamation, Mining and Safety <br /> Df Natural Resources <br /> an Street, Room 215 <br />)rado 80203-2273 <br /> Mathew Valdez <br /> Costilla County <br /> P.O. Box 130 <br /> San Luis, CO 81152 <br /> SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> le Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. X ❑Agent <br /> 13 Print your name and address on the reverse ❑Addressee <br /> so that we Can return the card to you. B. Received by(Printed Name) C. Date of Delivery <br /> m Attach this card to the back of the mailpiece, <br /> or on the front if space permits. <br /> D. Is delivery address different from item 1? ❑Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑ No <br /> Mathew Valdez <br /> Costilla County <br /> P.O.Box 130 <br /> San Luis,CO 81152 <br /> 3. Service Type <br /> ❑Certified Mail' ❑Priority Mail ExpressTI' <br /> ❑Registered ❑Return Receipt for Merchandise <br /> ❑ Insured Mail ❑Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7 014 0150 0000 9138 4115 <br /> (Transfer from service label) <br /> PS Form 3811,July 2013 Domestic Return Receipt <br /> i <br /> Postal <br /> CERTIFIED MAILI-.t RECEIPT <br /> L7 LJ1 (Domestic Mail Only; ..• Provided) <br /> r-1 rq <br /> deliveryr-q For <br /> CO Cc OFFICIAL USE <br /> m m <br /> a r-q Postage $ <br /> Certified Fee <br /> - P E3 E3 Return Receipt Fee � <br /> E3 C3 (Endorsement Required) <br /> Restricted Delivery Fee <br /> (Endorsement Required) <br /> s Ln Lrl <br /> r9 r-9 Total Postage&Fees $ <br /> E3 Q <br /> Sent o Mathew Valdez <br /> ra r9 Costilla County <br /> ❑ a <br /> SL eef i1pG 111p j-»- PC.Box 130 <br /> of PO <br /> {� N dii-Box No. •---- <br /> San Luis,CO 81152 ....»......... <br /> PS Form :0i August 2006 S"-Reverse for Instructions <br />