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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION DIV DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. X Patrick 9[)'onrt 'll Agent <br /> ■ 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 Deliver <br /> ■ 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 /> United Fire & Casualty Company <br /> 118 Second Avenue SE <br /> P O Box 73909 3. Service Type <br /> Cedar Rapids, IA 52407-3909 ®Certified Mail® ❑Priority Mail Express- <br /> 0 Registered 13 Return Receipt for Merchandise <br /> ❑ Insured Mail 1:1 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 labeq <br /> PS Form 3811,July 2013 Domestic Return Receipt <br /> UNITED STATES POSTAL SERVICE <br /> First-Class Mail <br /> Postage&Please print Permit No.G-10 in thi Fees Paid <br /> r; <br /> Sende USPS <br /> Your name, address, and ZiP+4® <br /> State of Colorado s box <br /> Department <br /> t of Natural Resources <br /> Division of Reclamation <br /> 1313 Sherman Street 'Mining&Safety <br /> Denver, � Suite 215 <br /> CO 80203 d6&074�4- r <br /> Spec <br /> File WIV 7a <br />