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)F COLORADO <br />mation, Mining and Safety <br />atural Resources <br />treet, Room 215 <br />D 80203-2273 <br />Broken Arrow Investments LLC <br />Doug Derr <br />801 8th St., Ste 130 <br />Greeley, CO 80631-3903 <br />SENDER: COMPLETE THIS -SECTION <br />IS Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />O 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 mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />Broken Arrow Investments LLC <br />Doug Derr <br />801 8th St , Ste 130 <br />Greeley, CO 80631-3903 <br />2. Article Number <br />(Transfer from service label) <br />PS Form 3811, July 2013 <br />COMPLETE THIS SECTION ON DELIVERY <br />A, Signature <br />X <br />B. Received by (Printed Name) <br />0 Agent <br />0 Addressee <br />C. Date of Delivery <br />D. Is delivery address different from item 1? 0 Yes <br />If YES, enter delivery address below: 0 No <br />3. Service Type <br />0 Certified Mair 0 Priority Mail Express'" <br />0 Registered 0 Return Receipt for Merchandise <br />0 insured Mail 0 Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) 0 Yes <br />7014 0150 0000 9138 3835 <br />Domestic Return Receipt <br />0150 0000 9138 3835 <br />rR <br />0 <br />N <br />0150 0000 9138 3835 <br />ri <br />0 <br />N <br />1 <br />ostal Servicer,. <br />CERTIFIED MAIL,. RECEIPT <br />(Domestic Mail Only; No Insurance Coverage Provided) <br />Por delivery information visit our website at www.usps.comE <br />Pastag <br />Certified F <br />Return Rece0 Fee <br />(Endorsement Required) <br />Reesicted Delivery Frio <br />(Endorsement Required) <br />Tota! Postage & Fees <br />Sent To <br />or PO Box No. <br />Broken Arrow Investments LLC <br />Doug Derr <br />801 8th St., Ste 130 <br />Greeley, CO 80631-3903 <br />PS r.,,,,, .qtm; Auqu t : ti; , <br />