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COLORADO <br /> Division of Reclamation, <br /> Mining and Safety <br /> Department of Natural Resources <br /> 1313 Sherman Street,Room 215 <br /> Denver,CO 80203-2243 <br /> 341300000 <br /> Mike Bennett <br /> 39533 Co. Rd. 18 <br /> Holyoke, CO 80734 <br /> SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3. r/la A. Signature <br /> ■ Print your name and address on the reverse X ❑Agent <br /> so that we can return the card to you. ❑Addressee <br /> • Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery <br /> or on the front if space permits. <br /> D. Is delivery address different from item 1? El Yes <br /> If YES,enter delivery address below: ❑ No <br /> Mike Bennett <br /> 39533 Co. Rd. 18 <br /> Holyoke, CO 80734 <br /> I IIII I'I �I(I� ( I I I I I i l IIII 3. Service Type ❑Priority Mail Expresso <br /> 11 <br /> ❑Adult Signature Q Registered MaiIT" <br /> ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted <br /> ❑Certified Mail® Delivery <br /> 9590 9402 2543 6306 1179 18 ❑Certified Mail Restricted Dellvery ❑Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(transfer from service label) ❑Collect on Delivery Restricted Delivery El Signature ConfirmationTM <br /> Mail El Signature Confirmation <br /> 7 18 2290 O L 8923 6347 vlail Restricted Delivery Restricted Delivery <br /> )ol <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br /> Postal <br /> CERTIFIED o RECEIPT <br /> f� It Domestic Mail Only <br /> M m <br /> m m <br /> _ ru rU Certified Mail Fee <br /> Q' a— $ <br /> cO cO Extra Services&Fees(check box,add tee as appropriate) <br /> ❑Return Receipt(hardcopy) $ <br /> s ❑Return Receipt(electronic) $ Postmark <br /> M 0 <br /> ❑Certified Mail Restricted Delivery $ Here <br /> --- � ❑Adult Signature Required $ <br /> ❑Adult Signature Restricted Delivery$ <br /> p p Postage <br /> . Q— rr $ <br /> rU rU Total Postage and Fees <br /> rU ru <br /> cO rO Sent To <br /> r-q rq ____ Mike Bennett <br /> O O Street and Apt.No.,or 1 <br /> r 39533 Co. Rd. 18 <br /> city siaie;zfP+a�----- Holyoke, CO 80734 ------------------------------ <br /> :rr r rr •r. - <br />