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COMPLETE • DELIVERY1 <br /> ■ Complete items 1,2,and 3. A. SignatWIre <br /> ■ Print your name and address on the reverse <br /> y El Agent <br /> so that we can return the card to you. P Addresse <br /> IN Attach this card to the back of the mailpiece, "g Redeived by(Prnr)ed Name) d Date of Deliver <br /> or on the front if space permits. <br /> 1. Article Addressed to- g 'ddwery address different from item 1? ❑Yes <br /> -Y enter delivery address below: _ p No <br /> LueAnn Doebber <br /> High Country Bank <br /> 150 North Raynolds Ave, �> <br /> P O Box 1570 A, " <br /> Canon City, CO 81212 <br /> 3. Service Type ❑Priority Mail Express3 <br /> I ! I ❑Adult Signature ❑Registered MaiITM <br /> I' 'iI' I'I I�p)i,•f' ;I, ;) ,;' �;� ❑Adult Signature Restricted Delivery ❑Registered Mail Restnc <br /> i XCertified Mail@ Delivery <br /> 9590 9402 3438 7275 7 595 68 ❑Certified Mad Restricted Delivery ❑Return Receipt for <br /> �:]Collect on Delivery Merchandise <br /> 2. Article Number((r2n¢far frmm---f.k—n ❑ C Collect on Delivery Restricted Delivery El Signature Confirmation <br /> 7016 2 710 o i7 0 o 2965 4 3 4 1 `Insured Mail ❑Signature Confirmation <br /> ❑Insured Mail Restricted Delivery Restricted Delivery <br /> (over$$500) <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return ReceiF <br /> U G# <br /> First-Class Mail <br /> Postage&Fees Paid <br /> 111111 USPS <br /> imil[I[l] <br /> Permit No.G-10 <br /> 9590 9402 3488 7275 ?595 68 <br /> United States •Sender: Please print your name,address,and ZIP+4®in this box* <br /> Postal Service 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 ZC4 <br /> File lLi4eino <br /> --22=3&S <br />