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-;ENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> ■ Cor*ete;tems 1,2,and 3. ,A. Signature <br /> ■ (dint your name andaddress on the reverse X ❑Ager <br /> so that we'can return the card to you. 0• ❑Addr <br /> ■ Attach this card to the back of the mailpiece, Received by(Printed Name) C. Date of Dc <br /> or on the front if space permits. ; <br /> I• D. Is d�lirry address different from Rem 1? El Yes <br /> If VES,Onthr delivery address below: ❑No <br /> ~Lexon Surety Group <br /> 12890 Lebanon Road %,os Camp D <br /> Mt. Juliet, TN 37122-2870 uret 9Up <br /> 1289 <br /> 1� 3. Servic U iQ TN 37 <br /> . �.Iriil��I I'IIII IIIIII II III I I (III II I III ❑Adult Signature 12❑Priority Mail aTms <br /> 9 Registered Mailil <br /> ❑Adult Signature Restricted Delivery ❑Registered Mail Re' <br /> 9590 9402 2053 6132 7838 53 I9 Certified Mail® Delivery <br /> ❑Certified Mail Restricted Delivery ❑Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(Transfer frnm sarvira fahall ❑Collect on Delivery Restricted Delivery ❑Signature Confirma <br /> ❑Insured Mail ❑Signature Confirme <br /> '016 2140 0000 2345 5680 ❑Insured Mail Restricted Delivery Restricted Delivery <br /> _— (over$500) <br /> 3S Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Rey <br /> USK1RACMG., "- First-Class Mail <br /> Postage&Fees Paid <br /> USPS <br /> Permit No.G-10 <br /> 111111 <br /> 1590 9402 2053 6132 7838 53 <br /> A States r313Sherman <br /> e print your name,address,and ZIP+4®in this box* <br /> `al Service lorado <br /> t of Natural Resources <br /> Reclamation, Mining & Safety <br /> an Street, Suite 215 <br /> 80203 Spec S�Pao IS-oe�f File <br /> �Ilrirllill��l��nfl>>fl�ffil�iltrrMlr�rll�lirnll�rlli�l�flillii <br />