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SEND11JR:COMPLETE THIS SECTION COMPLETE THIS ON ON DELIVERY <br /> ■ Complete items 1,2,and 3. A. Signature <br /> ■ Print your name and address on the reverse X ❑Agent <br /> so that we can return the card to you. El Addressee <br /> ■ Attach this card to the back of the mallpiece, B. Received by( rinted Name) C. Date of Delivery <br /> or on the front if space permits. ^ <br /> 1. Article Addressed to; D. Is delivery address different from item 1? O Yes <br /> If YES,enter delivery address below; ❑ No <br /> Debbie Gibbs, Vice President <br /> Fort Morgan State Bank <br /> 520 Sherman Street <br /> Fort Morgan, CO 80701 <br /> 3. Service Type CJ Priority Mail E•prese) <br /> ❑I' Adu t S;nature ❑Registered Mail l" <br /> D Adu Delivery ❑ li <br /> lt Signature Restricted Delive Registered Mail Restricte 6(CertifiedMaihl Delivery <br /> l 1 „ ❑Certified Mail Restricted Delivery ❑Return Receipt for <br /> 9590 94102 25-r3 6306 1368 34 Merchandise <br /> Collect on Delivery <br /> 2. Article Number(transfer from service label) Collect on Delivery Restricted Delivery 1!Signature Confinnatio" <br /> 1i Insured Mail ❑Signature Corinrmation <br /> 7 016 2140 3 4 5 6 6 7 ]Insured Mail Restricted Delivery Restricted Delivery <br /> (oe er$500) <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> USPS TRACKING# <br /> First-Class Mail <br /> Postage&Fees Paid <br /> USPS <br /> Permit No.G-10 <br /> 9590 9402 2543 6306 1368 34 <br /> United States FEPARTMENTOF <br /> er:Please print your name,address,and ZIP+4®in this box• <br /> Postal Service <br /> E OF COLORADO <br /> NATURAL RESOURCES <br /> DIVISION OF RECLAMATION,MINING&SAFETY <br /> 1313 SHERMAN STREET,SUITE 215 <br /> DENVER,CO 80203-2243 <br /> JLt Spec. <br /> 1,�c- to i9�1d1+� File <br /> . ... ... . . . . . .. . . . . . . . . ... . <br /> Iflllflli iillfifiiilflillflilflilifilitflffil�il�li4iiffffifiijij <br />