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COLORADO <br /> Division of Reclamation, <br /> Mining and Safety <br /> Department of Natural Resources <br /> 1313 Sherman Street,Suite 215,Denver,CO 80203 <br /> 7014 2120 0001 7869 8183 <br /> 341300000 <br /> 7014 2120 0001 7869 8183 <br /> mj mm: m m`° <br /> 3$, 3X <br /> 3 • <br /> N� 2 y �o a n <br /> O l N Ll <br /> m <br /> m -n T N <br /> a A <br /> — w a <br /> w v <br /> n co <br /> rfl <br /> 00 • <br /> N <br /> O <br /> A, 3 <br /> m <br /> COMPLETE •N COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. X ❑Agent <br /> ■ Print your name and address on the reverse ❑Addressee <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: If YES,enter delivery address below: ❑ No <br /> Brian Busse <br /> 1437 G St. 3. Service Type <br /> Salida, CO 81201 ❑Certified Mail` ❑ Priority Mail Express`" <br /> ❑ Registered ❑ Return Receipt for Merchandise <br /> ❑ Insured Mail ❑ Collect on Delivery <br /> Go 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7 014 2120 0001 7869 8183 <br /> (transfer from service label) <br /> PS Form 3811,July 2013 Domestic Return Receipt <br />