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<br /> UNITED STATES POSTAL SERViCta ,- ~' -First-
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<br /> �.CERTIFIED MAILP RECEIPT "-
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<br /> U.S. Postal Service'"
<br /> rs Sender: Please print your name, address, and ZIPW in this box'
<br /> r'— Domestic Mail Only
<br /> -� f ( State of Colorado
<br /> Ln Department of Natural Resources
<br /> co Division of Reclamation,Mining&Safety
<br /> r- 'ostage: $0.675 1313 Sherman Street, Suite 215
<br /> r_q �ertified Fee: Spec ti,QyyjG
<br /> C3 $3.300 Denver, CO 80203 W C3 (EReturn Receipt Fee: $2.700 File to -zddc5_ob7
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<br /> ru rotal Postage and Fees: $6.675
<br /> ,_j Total Postage
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<br /> sent To )llli'Illlillliil lsiill slsllsssitli)Irslsl�ils�llsssslslllllls!
<br /> � Street&slpt.IVo.,
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<br /> or PO Box No.
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<br /> Csty,State,Z/P+4
<br /> PS Form 3800,July 2014 See Reverse for instructions
<br /> Certified Mail service provides the following benefits:
<br /> ■A Certified Mail receipt(t6peo o(WL ;include applicable postage to
<br /> Certified Mail label). _.,ov the return receipt service fee;and
<br /> is A unique identifier for YoulFIleiecer,,l.aW 4 WIZ2the mailpiece"Return Receipt
<br /> e Electronic verification of delivery or a mpted RuLlutsulu,"or see a retail associate for
<br /> delivery. &4G assistance.For an electronic return receipt,
<br /> ■A record of delivery(including the recipient's see a retail associate for assistance.To
<br /> signature)that is retained by the Postal receive a duplicate return receipt,present
<br /> Seance'for a specified period. this USPSO-postmarked Certified Mail
<br /> Important Reminders:
<br /> COMPLETE THIS SECTION ON DELIVERY receipt to'he retail associate,who will COMPLETE ■You may purchase Certified Mail service with p
<br /> rovide ddit onaldfeelicate return receipt for no
<br /> Fust-Class Mait',First-Class Package Restricted delivery service,which provides
<br /> ■ Complete items 1,2,and 3.Also complete A. Si ture Service ,or Priority Mail service.
<br /> p p delivery to the addressee specified by name,
<br /> item 4 if Restricted Delivery is desired. X ❑Agent ■Certified Mail service is not available for or to the addressee's authorized agent.
<br /> international mail. Include applicable postage
<br /> ■ Print our name and address on the reverse �.l ❑Addressee ppicabletocoverthe
<br /> y el 1 ■Insurance coverage is notavailable for restricted delivery fee and endorse the
<br /> so that we can return the card to you. B. Received by(Pri ofName) C. ate of Delivery purchase with Certified Mail service.However, mailpiece"Restricted Delivery,"or see a
<br /> ■ Attach this card to the back of the mailpiece, the purchase of Certified Mail service does not retail associate for assistance.
<br /> or on the front if space permits. 11 V 1 I I change the insurance coverage automatically in To ensure that your Certified Mail receipt is
<br /> D. Is delivery address different from item 1? ❑Yes included with certain Priority Mail items. accepted as legal proof of mailing,it should
<br /> 1. Article Addressed to: ■For an additional fee,you may request the bear a USPS postmark.If you would like a
<br /> If YES,enter delivery address below: ❑ No following services: postmark on this Certified Mail receipt,please
<br /> Return receipt service,which provides you present your Certified Mail item at a Past
<br /> -- — — -- with a record of delivery(including the Office"for postmarking.If you don't need a
<br /> recipient's signature)You cap,r�p e pgs mark on this Cpy�J�ified Mail receipt,detach
<br /> Mr. Randall Roberson hardcopyreturnreceiptorab��cW1313thD • M.ddtle3Tof this label,affix ittothe
<br /> version.For a hardcopy returp,eceigt,� c�, pply appropriate postage,and
<br /> TBK Bank, formerly complete PS Form 3811,RosWt'�3,EtrYt- F, COd -ttf ailpiece.
<br /> Receipt,,attach PS Form 3811 to your IMPORTANT:Save this receipt for your records.
<br /> Colorado East Bank & Trust 3. Service Type PS Form 3800,July 2014(Reverse)PSN 7530-02-000-9047
<br /> P O Box 930 Eff Certified Mail® ❑Priority Mail Express- - -
<br /> La Junta, CO 81050 ❑Registered ❑Return Receipt for Merchandise
<br /> ❑ Insured Mail ❑Collect on Delivery
<br /> 4. Restricted Delivery?(Extra Fee) ❑Yes
<br /> 2. Article Number 7 014 2120 0001 7885 6347
<br /> (Transfer from service labeg
<br /> PS Form 3811,July 2013 Domestic Return Receipt
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