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COMPLETESENDLR:COMPLETE THIS SECTION � <br /> ■ Complete items 1,2,and 3. A. Signature <br /> ■ Print your name and address on the reverse X l Agent <br /> so that we can return the card to you. T t ❑Addresse <br /> ■ Attach this Card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Deliver <br /> ft <br /> or on the front if space permits. , J f,, I � Y I� _ <br /> 1. Article Addressed to: D` Is delivery address different from item 1? ❑Yes <br /> If YES,enter delivery address below; 1%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 Exp re s ) <br /> ' E Adult Signature El Registered Ma <br /> I I C Adult Signature Restricted Delivery ❑Reistered Mail Restnc1 <br /> IC Certified WHO Delivery <br /> 9590 9402 3488 72715 7595 99 ❑Certified Mad Restricted Delivery ❑Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2, Article Number(Transfer from service labeb ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation <br /> ❑Insured Mail 0 Signature Confirmation <br /> 7016 2 710 0000 2965 4356 ❑Insured Mail Restncted Delivery Restricted Delivery <br /> (over$500) <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return ReceiF <br /> UM MG# <br /> First-Class Mail <br /> Postage&Fees Paid <br /> USPS <br /> Permit No.G-10 <br /> 9590 9402 3488 ?2?5 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_c4 <br /> /4/p/ GS File M 14910V <br /> ff}lllil�lllljfflll'lilfli#Iff�l��l)i�liffff�ll#fi�ifltfiiil�il�i <br />