2017-01-12_GENERAL DOCUMENTS - M2001018

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UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 ' • SeCERTIFIED rvice'" Permit RECEIPT u- Domestic , • Sender: Please print your name, address, and ZIP+4®in this box* C3 o State of Colorado Department of Natural Resources o cc $ . Certified Fee: $ oo � Division of Reclamation,Mining&Safety C3 (I Return Receipt Fee: $ V Gark1��' y 1313 Sherman Street, Suite 215 3 Denver, CO 80203 Spec ��-e C3 tl Total Postage & Fee: $6 --�"S File�ZoOi-o'6 n, I ��I��\- 01 r-9 Total Postage&Fees ru Sent To 4 P_A(V�, M-LV"VtiJ eS�d _ %� /ll r flr r r 1 ilil 1 Ir r r r r r' rr 1 1't Street&A-f-No.,-------------- -- — h---X--j-- --------------- rl 11 11 1111111111 1 1 1 1 11 Ir 11 tll 11 1 ! uUl C3 or PO Box No `Zy3 �� \�3/ - '�C 1 T ------------------- City,State,ZIP+4 Cam,`1.'A e V ki UI �ji PS Form 3800,July 2014 See Reverse for Instructions Certified Mail service provides the following benefits: ■A Certified Mail receipt(this portion of the mailpiece;include applicable postage to Certified Mail label DLV cover the return receipt service fee;and ■A unique identifier oNviailpiece. endorse the mailpiece"Return Receipt ■Electronic verificatiod of delivery or a emp e u see aFetail associate for delivery. tM 6 \—O,, assistance.For an electronic return receipt, ■A record of deliverFj&#ig the recipient's see a retail associate for assistance.To signature)that is retained by the Postal in receipt,present Service®for a specified period. S1-0 - this USPS®-postmarked Certified Mail receipt to the retail associate,who will COMPLETE • •AIPI,ETE THIS SECTION ON DELIVERY ■nYou may purchase reCertified Mail service with 1provide a duNecate return receipt for no additional fee. First-Class Mail®,First-Class Package Restricted delivery service,which provides ■ Complete items 1,2,and 3.Also complete A. Sign ure Service®,or Priority Mail®service. ry p item 4 if Restricted Delivery is desired. X El Agent ■Certified Mail service is notavailable for delivery to the addressee specified by name, or to the addressee's authorized agent. ❑Addressee international mail. ■ Print your name and address on the reverse Include applicable postage to cover the ■Insurance coverage is notavailable for restricted delivery fee and endorse the so that we can return the Card to you. Received by(Printed Name) D t f De ivery purchase with Certified Mail service.However, mailpiece"Restricted Delivery,"or see a ■ Attach this card to the back of the mailpiece, ^ l� the purchase of Certified Mail service does not retail associate for assistance. or on the front if space permits. �^ change the insurance coverage automatically ■To ensure that your Certified Mail receipt is D. Is delivery address different from item 1? ❑Yes included with certain Priority Mail items. accepted as legal proof of mailing,it should 1. Article Addressed to: If YES,enter delivery address below: ❑No ■For an additional fee,you may request the bear a USPS postmark.If you would like a following services: postmark on this Certified Mail receipt,please Return receipt service,which provides you present your Certified Mail item at a Post with a record of delivery(including the Office"for postmarking.If you don't need a `�,��Ci ` G;KS+c N t,11�✓1 CJCW�L(�Ct.1t, recipient's signature).You can request a postmark on this Certified Mail receipt,detach J hardcopy return receipt or an electronic the barcoded portion of this label,affix it to the version.For a hardcopy return receipt, mailpiece,apply appropriate postage,and I comp P$ orr 11 opmesficRityRr R depo i e ailpiece. ((�� 6oz Rece R 9S1w SL q" . I �J• 1 3. Service Type Ps Form 3800,JUIY2014(Reverse)PSN 7530-02-000-9047 LZCertified Mail® ❑Priority Mail Express- 0 Registered ❑ Return Receipt for Merchandise l ❑ Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7014 2120 0001 8040 1009 (transfer from service label} PS Form 3811,July 2013 Domestic Return Receipt