Laserfiche WebLink
UNITED STATES POSTAL SERVICE First-Class Mail <br /> Postage&Fees Paid <br /> . _. USPS <br /> Permit No.G-10 <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 <br /> 1313 Sherman Street, Suite 215 <br /> Denver, CO 80203 r yr ��, Spec e,kk!- <br /> File m -:?ojWt4 <br /> �ENDER: COMPLETE THIS SECTION COMPLEfE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. ❑Agent <br /> ■ Print your name and address on the reverse X0-eakf El Addressee <br /> so that we can return the card to you. B. RAelved b Printed Name) C. ate of liver <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? e <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑No <br /> Mr. Jerry Gross, President <br /> Bank of Burlington <br /> P O Box 427, 410 14th Street 3. Service Type <br /> Burlington, CO 80807 G%Certified Mail® ❑Priority Mail Express- <br /> ❑Registered ❑Return Receipt for Merchandisi <br /> ❑ Insured Mail ❑Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number D�0'1 7885 6514 <br /> (Transfer from service faben <br /> PS Form 3811,July 2013 Domestic Return Receipt <br />