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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3. A. Signature <br /> ■ Print your name and address on the reverse X ❑Agent <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. <br /> 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes <br /> If YES,enter delivery address below: ❑ No <br /> MR ADAM SCHULTEJANN <br /> 120 85 LLC <br /> 10925 EAST 120TH AVENUE <br /> HENDERSON,CO 80W <br /> ��I IIIIII I II I'I I II �IIII I II III II II III �� I 3. Service Type ❑Priority Mail Express© <br /> ❑Registered <br /> ❑Adult Signature Maih'" <br /> ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted <br /> 9590 9402 2053 6132 7839 76 Certified Mad® Delivery <br /> ❑Certified Mail Restricted Delivery ❑Return Receipt for <br /> El Collect on Delivery Merchandise <br /> 2 Article Number(Transfer from service label) ElCollect on Delivery Restricted Delivery 0 Signature ConfirmationTM <br /> Insured Mail ❑Signature Confirmation <br /> ❑Insured Mail Restricted Delivery Restricted Delivery <br /> 7014 2120 0001 7885 4206 <br /> PS Form 3811,July 201 —)stic Return Receipt <br /> Postal <br /> CERTIFIED aRECEIPT <br /> C3 C3 Domestic Mail Only <br /> nu fU <br /> For delivery information,visit our websilte at wwwusps- <br /> _ co CO <br /> CO cc Postage $ <br /> 171- r� <br /> Certified Fee <br /> r 3 r3 Postmark <br /> Return Receipt Fee <br /> O EJ (Endorsement Required) Here <br /> O O <br /> Restricted Delivery Fee <br /> p p (Endorsement Reqwred) <br /> nJ rU <br /> ru Total Postage 8 Fees <br /> Sent To <br /> • o r-1 r-q _______________________ MR ADAM SCHULTEJANN ---------- <br /> �� p Q Street&Apt No., 120 85 LLC <br /> N r or PO Box--- 10925 EAST 120TH AVENUE -------------- <br /> City,State,ZIP+4 HENDERSON,CO 80640 <br /> L PS Form :rr July 2014 <br /> ANK OF THE EST <br /> 120 85 LLC 215 S WADSWORT'H BLVD <br /> 10925 E. 120TH Avenue LAKEWOOD,CO 80226-1535 <br /> Henderson,CO 80640-9733 82-214n070 <br /> 7/9/2018 <br /> PAY TO THE "*791.00 <br /> ORDER OF Mined Land Reclamation Board <br /> Seven Hundred Ninety-One and 00/100#****** *#***"" * ***** #********h*x*******************#***************** #*******i DOLLARS <br /> Division of Reclamation, Mining & Safety <br /> Department of Natural Resources <br /> 1313 Sherman Street, Room 215 j.a.._ <br /> Denver, Co 80203 <br /> MEMO Attn: Barbara - <br /> __M-2001-085_Annual Fee_________ __________ <br /> I - <br />