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• Sender: Please print your name, address, and ZIP+4® in this box• <br />..i�G <br />State of Colorado <br />Department of Natural Resources <br />Division of Reclamation, Mining & Safety Qct eG�a <br />1313 Sherman Street, Suite 215 P 0&� be, <br />Denver, CO 80203 SL -10 <br />C-1981-041 <br />jhblahh Inspection <br />t � ; t ttiiii3,i.lof,f�:la���R�lficlatioll�::'t{ <br />iiiTi� �aii: � }� 't" ►'il .li, l <br />■ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />■ Print your name and address on the reverse <br />so that we can return the card to you. <br />■ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />Town of Palisade <br />P.O. BOX 128 <br />Palisade, CO 81526 <br />A. Sign re J[ <br />X 41 Agent <br />❑ Addressee <br />B. R i <br />b C.. Date Dellro�ry <br />D. delive address different item ? 0 Yes <br />f YES, enter delivery address elow: ❑ No <br />APP 1 4 2011 <br />3. Se 'ce Tp 6 <br />El 'c <br />RrI N ail Express - <br />11 Register urn Receipt for Merchandise <br />❑ Insured Mail ❑ Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) <br />2. Article Number ❑ Yes <br />(transfer from service label) 7 014 0150 0000 913 8 5259 <br />PS form 3811, July 2013 <br />Domestic Return Receipt <br />