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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 _ X Agent <br /> so that we can return the card to you. - _ - 13 Addresse <br /> ■ Attach this card to the back of the mailpieee, B. Received by(Printed Name) C. Date of Deliver <br /> or on the front if space permits. ' ! ` ' r" r I <br /> C k I� _ <br /> 1. Article Addressed to: D. Is delivery address different from item 1? ❑ Yes <br /> If YES,enter delivery address below; .g No <br /> Mr. Mike Tezak <br /> Tezak Stone&Aggregate Supply, Inc. <br /> 6200 County Road 37 <br /> Cotopaxi, CO 81223 <br /> 3. Service Type ❑Prionty Mail Express5 <br /> I ❑Adult Signature ❑Registered Mail <br /> El Adult Signature Restricted Delivery ❑Registered Mail Restnc <br /> q Certified Madre Delivery <br /> 9593 9402 3488 7275 7595 99 ❑Certified Mail Restricted Delivery ❑Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation <br /> ❑Insured Mad ❑Signature Confirmation <br /> 7 01,6 2 71,0 0000 2965 4 356 ❑Insured Mail Restricted Delivery Restricted Delivery <br /> (over$500) <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receir <br /> �kEifNdG# <br /> First-Class Mail <br /> Postage&Fees Paid <br /> USPS <br /> Permit No.G-10 <br /> 9590 9402 3488 7275 7595 99 <br /> Uniteq States •Sender:Please print your name,address,and ZIP+4®in 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 Spec_ <br /> / p/ GS File M 1491.4 D <br /> ttl!!IlI�I'il��,iilllllslllltr�l��llljlistsi�ll�tl�i}I1:1111�1l�I <br />