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COLORADO <br /> Division of Reclamation, <br /> Mining and Safety <br /> Depa to-.2r.`of Natural Resocr :. <br /> 1313 Sherman Street,Suite 215 Denier co 60203 7014 2120 0001 7869 8237 <br /> 341300000 <br /> 7014 2120 0001 7869 8237 <br /> m a m <br /> m oy o <br /> v mom; T <br /> N; o w v 7o m • <br /> al o m mm m m aa • <br /> p, .py, " <br /> c2 c� m <br /> CD mm i9 <br /> i N +iD am m 12 <br /> m • . <br /> w <br /> O _ <br /> O N <br /> in V1 fD <br /> N 00 N O <br /> v <br /> r1 ui � <br /> O o <br /> 0 <br /> • <br /> m <br /> r <br /> COMPLETE •N COMPLETE THIS SECTIONON DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. ❑Agent <br /> ■ Print your name and address on the reverse X ❑Addresses <br /> so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. <br /> D. Is delivery address different from item 1? ❑Yes <br /> 1. Article Addressed to: rW;110/plo � If YES,enter delivery address below: ❑No <br /> Blain Klett <br /> 14092 5875 Road 3. Service Type <br /> Montrose, CO 81401 ❑Certified Mail® ❑ Priority Mail Express'" <br /> ❑ Registered ❑ Return Receipt for Merchandise <br /> ❑ Insured Mail ❑ Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7014 2120 0001 7869 8237 <br /> (Transfer from service fabeq <br /> PS Form 3811,July 2013 Domestic Return Receipt <br /> I <br />