|
COMPLETE •N COMPLETE THIS SECTIONON DELIVERY
<br /> ■ Complete items 1,2,and 3. A. Signature
<br /> ■ Print your name and address on the reverse X ¢d Agent
<br /> so that we can return the card to you. �� ;z Addresse
<br /> ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date,._Qf Deliver
<br /> or on the front if space permits_ r"' r�-,, G y ___i • : •7�1,
<br /> '1 Article Addressed to- D. Is delivery address different from item 1? ❑ Yes
<br /> Dean Goss If YES,enter delivery address below: p No
<br /> c/o audra Goss
<br /> 24040 Falcon Hwy.
<br /> Calhan, CO 80808-9156
<br /> 3. Service Type ❑Priority Mail Expresso
<br /> ❑Adult Signature ❑Registered Mail-
<br /> 0 Adult Signature Restricted Delivery ❑Reg�sterad Mail Restric
<br /> ❑Certified Mad© Delivery
<br /> ❑Certified Mad Restricted Delivery ❑Return Receipt for
<br /> ❑Collect on Delivery Merchandise
<br /> n ti_ n,f, �an,,,o lotion 01 Collect on Delivery Restricted Delivery Ll Signature Confrmaton
<br /> Mad ❑Signature Confirmation
<br /> 7 016 2710 0000 2965 4493 Mail Restricted Delivery Restricted Delivery
<br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Recelf
<br /> Certified Mail service provides the following benefits: U.S. Postal Service
<br /> ■A receipt(this portion of the Certified Malllabeq. for an electronic return receipt,see a retail CERTIFIED MAILO RECEIPT,
<br /> •A unique identifier ociate for assistance.To receive a duplicate
<br /> P, Warm
<br /> ■Elech TC1 W-13E SLB 1m receipt for no additional fee,present this M Domestic •
<br /> •, tmarked Certified Mail receipt to the
<br /> nly
<br /> dehve M-1985-140 Id
<br /> oclate.
<br /> ■A record of de er Return Ann Fee/Docs
<br /> sign delivery service,which provides
<br /> fora s d er nlhe addressee specified by name,or
<br /> the addressee's authorized agent. -
<br /> lmportantReminder:. -Adultsignatureservice,whichreguiresthe � " postage �p 47
<br /> ■You may purchase Certified Mail service with signee to be at least 21 years of age(not 1,0 oz. $3
<br /> First-Class Mad®,First-Class Package Service•, available at retail). J Q.1 to 45
<br /> or Priority Mad®service. Adult signature restricted delivery service,which (�,grtlf led Fee' $2.7 5 ^
<br /> ■Certitied Mail service is notavallable for requires the signee to be at least 21 years of age = Return Rece+pt Fee'.
<br /> international mail. and provides delivery to the addressee specified
<br /> ■Insurance coverage Is not available for purchase by name,or to the addressee's authorized agent
<br /> with Certified Mad service.However,the purchase (not available at retail). 12 e & Fees: $6
<br /> of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Total P ostag -
<br /> insurance coverage automatically included with accepted as legal proof of mailing,it should bear a `
<br /> certain Priority Mad items. LISPS postmark If you would like a postmark on
<br /> ■For an additional fee,and with a proper this Certified Mad receipt,please present your , T'''l''="1a14`31"
<br /> endorsement on the mailpiece,you may request Certified Mad item at Post Office'"for Dean Goss -�--
<br /> the following services: postmarking.If you don't need a postmark on this 5 -
<br /> -Return receipt service,which provides a record Certified Mad receipt,detach the barcoded portion c;o A udra Goss
<br /> of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply
<br /> You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. �_ 2.1040 Falcon Hw v.
<br /> electronic version.For a hardcopy return receipt, Calhan, CO 80808-9156
<br /> complete PS Form 3811,Domestic Return
<br /> RecORMSYM9� hie�Q�pl( re•eh'r 11COfdS.
<br /> PS Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 a '
<br /> USPS TRACIWG#
<br /> First-Class Mail
<br /> Postage&Fees Maid
<br /> USPS
<br /> Permit No.G-10
<br /> 9590 9402 3488 7275 7555 46
<br /> United States •Sender:Please print your name,address,and ZIP+4®)n this box•
<br /> Postal Service
<br /> State of Colorado
<br /> Department of Natural Resources
<br /> Division of Reclamation,Mining&Safety
<br /> 1313 Sherman Street, Room 215
<br /> Denver,CO 80203 rc1 wIM s1B
<br /> M-1985-140
<br /> Return Ann Fee(Docs
<br /> illrllll'll�'�1�'li#1"{�Ill�l�l�l'li�'i{htlttlfi+tii�(il'Ifl'#�!
<br />
|