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COLORADO <br /> Division of Reclamation, <br /> Mining and Safety <br /> Department of Natural Resources <br /> 1313 Sherman Street,Room 215 <br /> Denver,CO 80203-2243 <br /> 341300000 <br /> Daniel J. Gaudreault <br /> Daniel J. Gaudreault and Barbara J. Gaudreault <br /> P.O. Box 69 <br /> Elizabeth,CO 80107 <br /> COMPLETE .N COMPLETE THIS SECTIONON DELIVERY <br /> a Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. ❑Agent <br /> ■ Print your name and address on the reverse X ❑Addressee <br /> so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. <br /> D. Is delivery address different from item 1? []Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑No <br /> Daniel J.Gaudreault <br /> Daniel J.Gaudreault and Barbara J.Gaudreault <br /> P.O.Box 69 <br /> Bizabeth,CO 80107 <br /> 3. Service Type <br /> ❑Certified Mail® ❑Priority Mail Express' <br /> ❑Registered ❑Return Receipt for Merchandise <br /> ❑Insured Mail ❑Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7 014 2120 0001 8040 1504 <br /> (transfer from service label) <br /> i PS Form 3811,July 2013 Domestic Return Receipt <br /> Postal Service"" <br /> • , MAILO RECEIPT <br /> C3 /• • <br /> nly <br /> � Q <br /> N <br /> 0 <br /> O O Postage $ <br /> C0 <br /> Certified Fee <br /> r=1 r-q Postmark <br /> .� E3 p Return Receipt Fee Here <br /> ��■ O p (Endorsement Required) <br /> C3 O <br /> Restricted delivery Fee <br /> C3 C3 (Endorsement Required) <br /> ru ru <br /> r9 ra Total Postage&Fees <br /> ru ru <br /> *2- Sen•T^ Daniel J.Gaudreault <br /> ra rl -- Daniel J.Gaudreault and Berbera J.Gaudreault •-.------• <br /> O O P.O.Box 69 <br /> orF Ei¢abeth,CO 80107 <br /> tel: <br /> PS Form <br /> :.r July 2014 <br />