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�■ . . ■ <br /> ■ Complete items 1,2,and 3. A. Signature <br /> ■ Print your name and address on the reverse BCAgent <br /> so that we can return the card to you. ❑Addressee <br /> ■'Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery <br /> or on the front if space permits. 6,L)6b" J, N&5 kjeZ ii '5•ZZ I <br /> 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes <br /> If YES,enter delivery address below: Q No <br /> MR ABE VASQUEZ <br /> HECTOR RODRIGUEZ <br /> P.O. BOX 122 <br /> LYONS, CO 80540 <br /> III III II I II I I II I I II I II III II I I I I III I I I 3. Service Type ❑Priority Mail Express© <br /> ❑Adult Signature ❑Registered MailTM <br /> ❑Adult Signature Restricted Delivery ❑Registered Mail Restricte <br /> CLCertified MZ0 Delivery <br /> 9590 9402 2053 6132 7838 84 ❑Certified Mail Restricted Delivery El Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(Transfer from service label) El <br /> 2. on Delivery Restricted Delivery 0 Signature Confirmation" <br /> ❑Insured Mail El Confirmation <br /> 7 016 2140 0000 2345 5734 Insured Mail Restricted Delivery Restricted Delivery <br /> (over$$500) <br /> :IS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> USPS TRACKING# <br /> First-Class Mail <br /> Postage&Fees Paid <br /> USPS <br /> Permit No.G-10 <br /> 9590 9402 2053 6132 7838 84 <br /> United States •Sender:Please print your name,address,and ZIP+4®in this box* <br /> Postal Service State of Colorgdo <br /> Department tural Resources <br /> Division of Rt, ation, Mining & Safety <br /> 1313 Sherman Street, Suite 215 <br /> Denver, CO 80203 Spec PfWte- <br /> M 1 a RqV&z_ File <br />