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SENDER., COMPLETE-THIS.SECTION.,.. <br />■ Complete Items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />■ Print your name and address on the reverse <br />so that we can return the card to you. <br />■ Attach this card to the back of the rnailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />Home State Bank <br />Attn: Sherry Lightbody <br />P O Box 329 <br />Loveland, CO 80539-0329 <br />COMPLETE THIS, SECTION ON DELIVERY <br />A. Signat <br />X/ <br />4c� <br />B. Rec ived by (Printed Name) <br />D. Is delivery address different from item 1? 0 Yes <br />If YES, enter delivery address below: 0 No <br />Agent <br />0 Address <br />C. ►ate of I live <br />3. Service Type <br />Certified Mail" 0 Priority Mail Express" <br />0 Registered 0 Return Receipt for Merchandi <br />❑ Insured Mail 0 Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) 0 Yes <br />2 Article Number <br />(Transfer from service label) <br />PS Form 3811, July 2013 <br />7014 2120 0001 8040 1740 <br />QE: NR <br />UNITED STATES4$'1 SERVICE <br />Domestic Return Receipt <br />First -Class Mall <br />Postage & Fees Paid <br />USPS <br />Permit No. G-10 <br />• Sender: Please print your name, address, and ZIP+4® in this box• <br />State of Colorado <br />Department of Natural Resources <br />Division of Reclamation, Mining & Safety <br />1313 Sherman Street, Suite 215 <br />Denver, CO 80203 C 0 Akt,fil Spec F46L T1 d <br />Filey o3y <br />�„lli,1,11.lf1,,1111",i1+1,,ii1,11.111..1,1.1.1.11,111,141 <br />