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• • • • • ,• <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. l ❑Agent <br /> ■ Print your name and address on the reverse X "� _t�i ❑Address, <br /> so that we can return the card to you. B. Received by(Printed Name) C. Date of Delive <br /> ■ Attach this card to the back of the mailpiece, j <br /> or on the front if space permits. V I <br /> D Is delivery address different from item 19 ❑Yes <br /> 1. Article Addressed to If YES enter delivery address belovi ❑ No <br /> VIR LOUTS K GIRODO <br /> SAN JUAN COUNTY 3. Service Type <br /> 1512 GREEN"E ST ❑Certified Mail- ❑ Priority Mad Express" <br /> PO BOX 466 ❑ Registered ❑ Return Receipt for Merchandl� <br /> SILV ERTON.-00 81433 ❑ Insured Mail ❑ Collect on Delivery <br /> 4 Restricted Delivery?(Extra Fee) ❑ Yes <br /> 2. Article Number Lix„ 'J c) ()rr ( �}J q/ Z <br /> (Transfer from service label) V / G V l oo -( <br /> PS Form 3811,July 2013 Domestic Return Receipt <br /> UNITED STATES POSTAL SERVICE First-Class Mail <br /> Postage&Fees Paid <br /> LISPS <br /> Permit No.G-10 <br /> • Sender: Please print your name, address,and ZIP+4®in this box* <br /> STATE OF COLORADO <br /> DEPARTMENT OF NATURAL RESOURCES <br /> DIVISION OF RECLAMATION, MINING &SAFETY �(AO <br /> 1313 SHERMAN STREET, SUITE 215 ,^ <br /> DENVER, CO 80203-2273 <br /> Spec. <br /> File# <br />