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SENDER: COMPLETE THIS SECTION COMPLETE;THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signature ., <br /> item 4 if Restricted Delivery is desired. ElAgent <br /> Patrick 0"[ pn �� <br /> ■ Print your name and address on the reverse X ❑Addressee <br /> so that we can return the card to you. B. Received by(Printed Name) C.,,Date of Deliver <br /> ■ Attach this card to the back of the mailpiece, AJIJ <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 /> United Fire & Casualty Company <br /> 118 Second Avenue SE <br /> P 0 Box 73909 3. Service Type <br /> Cedar Rapids, IA 52407-3909 IN Certified Mail® ❑Priority Mail Express- <br /> El Registered ❑Return Receipt for Merchandise <br /> ❑ Insured Mail ❑Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7 014 212 0 0001 8040 0651 <br /> (Transfer from service label <br /> PS Form 3811,July 2013 Domestic Return Receipt <br /> UNITED STATES POSTAL SERVICE <br /> First-Class Mail <br /> Postage&Fees Paid <br /> USPS <br /> Permit No.G-io <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 r <br /> 1313 Sherman Street, Suite 215 <br /> Denver,C0 80203 't6 eO',"Ctl- <br /> Spec M.r:✓ <br /> File h !!�ro�� <br />