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UNITED STATES POSTAL SERVICE First-Class Mail <br /> Postage&Fees Paid <br /> LISPS <br /> Permit No.G-10 <br /> ' • Service" ECEIPT <br /> CERTIFIED MAILo . <br /> Domestic • Sender: Please print your name, address, and ZIP+4®in this box* <br /> C3 <br /> 0 <br /> 0 <br /> o State of Colorado <br /> Postage: Department of Natural Resources <br /> � $ _ <br /> Certified Fee: $ 00 � Division of Reclamation,Mining&Safety <br /> rkr�° � - 1313 Sherman Street, Suite 215 <br /> 0 o Return Receipt Fee: $ 6ra Y <br /> C3 Denver,CO 80203 Spec )Le <br /> C3 ° Total Postage & Fee: $6 '"��"' % File -Zook-ru ..VCIIH\" �' 01_ <br /> r-1 Total Postage&Fees s <br /> ru <br /> Sent To <br /> 4 ie_AV\- --- -- l,V1V1J�5t' ( _ rf111l1'J1IlrIrrrfllfllIIlllilllllrl'1'll+l!'!J'/II"I►1lllrJ1j11 <br /> - --- <br /> C3 or PO Box o �7"t3---------------- <br /> Z� 1\3' `- C�( ` 3 <br /> -------- ----- --- ---•---------------------- -City,State,ZIP+4 - - - - - - - <br /> PS Form 3800,July 2014 / See Reverse for instructions Certified Mail service provides the following benefits: <br /> ■A Certified Mail receipt(this portion of the mailpiece;include applicable postage to <br /> Certified Mail label). DL f cover the return receipt service fee;and <br /> ■A unique identifier tailpiece. endorse the mailpiece"Return Receipt <br /> ■Electronic verificatio od f delivery or a empte s e aretad associate for <br /> delivery. LppY-01� assistance.For an electronic return receipt, <br /> ■A record of dellverj((t{&#g the recipient's see a retail associate for assistance.To <br /> signature)that is retained by the Postal m m receipt,present <br /> Service"for a specified period. 5�'O I^ this USPS®-postmarked Certified Mail <br /> receipt to the retail associate,who will <br /> COMPLETE SECTION • SECTIONA,10).ETE THIS • ■N DELIVERY /You may purchaseortant eCertified Mail service with provide a duNilcate return receipt for no <br /> SENDER: First-Class Mail®,First-Class Package additional fee. <br /> ■ Complete items 1,2,and 3.Also complete P"trReiceived <br /> ure Service®,or Priority Mail'service. Restricted delivery service,which provides <br /> A ❑A ent delivery to the addressee specified by name, <br /> item 4 if Restricted Delivery is desired. g ■Certified Mail service is notavailable for or to the addressee's authorized agent. <br /> ❑Addressee international mail.■ Print your name and address on the reverse Include applicable postage to cover the <br /> so that we can return the card to ou. ■Insurance coverage is not available for restricted delivery fee and endorse the <br /> Y by(Printed Name) D t�-Qf De ivery purchase with Certified Mail service.However, mailpiece"Restricted Delivery,"or see a <br /> ■ Attach this card to the back of the mailpiece, i -�'/ the purchase of Certified Mail service does not retail associate for assistance. <br /> or on the front if space permits. �^ change the insurance coverage automatically ■To ensure that your Certified Mail receipt is <br /> D. Is delivery address different from item 1? ❑Yes included with certain Priority Mail items. accepted as legal proof of mailing,it should <br /> 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 <br /> r following services: postmark on this Certified Mail receipt,please <br /> fin ► a�ti !V.l;v��/t JeiS c?r -Return receipt service,which provides you present your Certified Mail item at a Post <br /> r- with a record of delivery(including the Office-for postmarking.If you don't need a <br /> JtiL��✓l:St r U A�K�'V vr1"1 tCXWIAA-.-V tZ. recipient's signature).You can request a postmark on this Certified Mail receipt,detach hardcopy return receipt or an electronic the barcoded portion of this label,affix it to the <br /> �ZLk-� t7 + version.For a hardcopy return receipt, mailpiece,apply appropriate postage,and <br /> � F-� �` compf'$ or 7J�omesSc R't{y(t R depo i e ailpiece. �+� <br /> Rece Fig gfi3d1C SL i�Woe7l ,Wards. <br /> - 6 t X , 3. Service Type PS Form 3800,July 2014(Reverse)PSN 7530-02-o0D-9047 <br /> A � I�'Certified Mail® ❑Priority Mail Express'" <br /> S•,��� tt l ,j tN ❑ Registered ❑ Return Receipt for Merchandise <br /> t ❑ Insured Mail ❑Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7 014 2120 0001 8040 1009 <br /> (Transfer from service labeg <br /> PS Form 3811,July 2013 Domestic Return Receipt <br />