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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3. A. Si ure <br /> ■ print your name and address on the reverse X (1� ❑Agent <br /> so that we can return the card to you. `�/ ❑Addressee <br /> ■ Attach this card to the back of the mailpiece, B. ceived b&' ted Na C. D to Delivery <br /> or on the front if space permits. tto <br /> 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes <br /> If YES,enter delivery address below: ❑ No <br /> Jason Lockard SEP 00 ??`� <br /> Washington County DIVISION OF RECLAMATION <br /> 501 E. 4th Ave. MINING AND SAFETY <br /> _Otis, CO 80743 <br /> I I I I III�I I II I I I I I I I I III I I I 3. Service Type ❑Priority xprE <br /> Mail Express® <br /> El Adult Signature ❑Registered <br /> Mail— <br /> El Adult Signature Restricted Delivery ❑Registered Mail Restricted <br /> ❑Certified Mail@ Delivery <br /> 9590 9402 2543 6306 1175 36 ❑Certified Mail Restricted Delivery ❑Return Receipt for <br /> ❑Collect on Delivery . Merchandise <br /> 2. Article Number(transfer from service label) ❑Collect on Delivery Restricted Delivery 0 Signature Confirmation^^ <br /> D Insured Mail ❑Signature Confirmation <br /> 7 017 2400 0000 9119 2843 Insured Mail Restricted Delivery Restricted Delivery <br />_ (over$500) <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br />