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COLORADO <br />Division of Reclamation, <br />Mining and Safety <br />Deparment cf Natural Re_v. rtes <br />1313 Sherman Street. Room 215 <br />Denver, CO 80203-2243 <br />341300000 <br />fin'<syu-a_=�ey� Wj`X =eo;ID <br />O W O C F; �, 2 <br />Oy.D^.,hen <br />wdS'a¢^n-y ny _ ��rn �m vd73 a �m 5�a U1 <br />4 6 <br />Ad ern m `=--� <br />a <br />'RR <br />w <br />o b C 4 v e n a Wo' y ro <br />�^ W acv a w.'n=Q--`�°'= W •2a 3A <br />aa <br />CL <br />• N <br />� $m3^ao�ip nn� �y Aad rp <br />^Co <br />�mo�c ge ar cCr�nm mm•����" aaN .� 0 <br />9"o�"��N�vo c^aTaiv<o�� a.f9o��,o�w3� <br />•i9ooc� n�icom yin " —y Rm_ hiie `�iy rQ <br />Cr <br />��n„°ipo �"'�y�=m c'+ 3 .Cni3��'. a7w �'+ M <br />`� K -• <br />Fa <br />yn_n oyc�,int 7_8 .nWm yr <br />amino.Ka oc ���3.t o = W y W <br />a e y y a N d c c Da" n o <br />Laurine Koellner <br />L & L Ready Mix <br />P.O. Box 218 <br />Haxtun, CO 80731 <br />f• Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />■ Print your name and address on the reverse <br />so that we can return the card to you. <br />■ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />Laurine Koellner <br />L & L Ready Mix <br />P.O. Box 218 <br />Haxtun, CO 80731 <br />A. Signature <br />X ❑ Agent <br />❑ Addressee <br />B. Received by (Printed Name) C. Date of Debvery <br />D. is delivery address different from item 14 ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />S. Service Type <br />❑ Certified Mail" ❑ Priority Mail Express- <br />❑ Registered ❑ Return Receipt for Merchand se <br />1 on 4. ❑Insured Mail ©Collect on Delivery <br />Restricted Delivery? (Extra Fee) 12 Yes <br />2. Article Number 7014 2120 0001 8040 1481 <br />(Transfer from servic <br />PS Form 3811 - July 2013 Domestic Return Receipt <br />