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�ENDER:COMPLETE THIS SECTION COMPLFTE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3. A Signa e <br /> ■ Print your name and address on the reverse ❑Agent <br /> 10 <br /> so that we can return the card to you. d <br /> ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Da Delivery <br /> or on the front if space permits. D <br /> I. Articl dressed to: D. Is delivery address different fro 1? Ell Yes <br /> Unite Fire & Casualty Company If YES,enter delivery addresstf. ❑ No <br /> P O Box73909 <br /> 118 Second Ave SE <br /> Cedar Rapids, IA 52407-39019 <br /> I)I III'I lily I'I I II III��I I)III ( I I I I 'I I I 3. Service Type ❑Priority Mail Express® <br /> El <br /> ❑Adult Signature ❑Registered MajITM <br /> ❑Adult Signature Restricted Delivery ❑Registered Mail ReStrICtE <br /> 9590 9402 2053 6132 7838 15 CiLCerhfied MailO Delivery <br /> ❑Certified Mail Restricted Delivery ❑Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationT" <br /> O Insured Mail ❑Signature Confirmation <br /> 2 016 2140 0000 2345 5659 or nsured <br /> (over$5 0)il Restricted Delivery Restricted Delivery <br /> 'S Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> LISPS TRACKNG# <br /> First-Class Mail <br /> Postage&Fees Paid <br /> USPS <br /> Permit No.G-10 <br /> 9590 9402 2053 6132 7838 15 <br /> United States •Sender:P:ease print your name,address,and ZIP+40 in this box- <br /> Postal Service <br /> State of orado <br /> Departmt of your <br /> Resources <br /> Division Reclamation, Mining & Safety1313 Shean Street, Suite 215Denver, 80203 Spec <<,--1 <br /> oY,� File <br />