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COMPLETE THIS SECTION ON DELIVERY <br /> SENDER:COMPLETE THISSECTION <br /> ■ Complete items 1,2,and 3.Also complete A ignature <br /> item 4 if Restricted Delivery is desired. Agent <br /> ■ Print your name and address on the reverse A ddressee <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,or on the front if space permits. _ <br /> D. Is delivery address different from item 1? Y Yes <br /> If YES,enter delivery address below: No <br /> Daryl Aubuchon <br /> The First National Bank in Trinidad <br /> 100 E. Main Street <br /> Trinidad CO 81082 3. Service Type <br /> ®Certified Mail® ❑Priority Mail Express'" <br /> ❑Registered ❑Return Receipt for Merchandise <br /> 0 Insured Mail ❑Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7 014 212 0 0001 8040 0743 <br /> (Transfer from service label) <br /> PS Form 3811,July 2013 Domestic Return Receipt <br /> UNITED STATE Ffl' yY'>-" <br /> ,f.,,AWOkj, ERVICE <br /> First-Class Mail <br /> r.. .,c ,4.- x Postage&Fees Paid <br /> uses <br /> • Sender: Please Y Permit No.G_10 <br /> Print our name address, and ZIP+4® <br /> In this box* <br /> State of Colorado <br /> Department of Natural Resources <br /> Division of Reclamation <br /> , ning 1313 Sherman Street, Suite 215 &Safety <br /> Denver,CO 80203 <br /> 1176' Spec tQ-rVlf, <br /> File a p40w <br /> ni <br /> 1 CiC.. ._ <br /> IIJI�iIJli�iiiiltJfJll�l;; <br />