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Summit Brick & Tile Co. Native/Pierre Mine <br /> Permit # M-1977-321 July 28, 2020 <br /> Proof of Placement Pueblo County Clerks Office - Completeness packet. <br /> SENDER:COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3. A. Si nature <br /> ❑Agent <br /> _ <br /> ■ Print your name and address on the reverse X � � = ❑Addressee <br /> so that we can return the card to you. 'Z" 4u <br /> ■ Attach this card to the back of the mailpiece, B. Received by rimed Name)Ij C.Date of Delivery <br /> or on the front if space permits. I 7 3/ZG <br /> 1. Article Addressed to: D. Is delivery address different from Item 1? ❑Yes <br /> If YES,enter delivery address below: ❑No <br /> DCil�f3E/ZT oeTi� <br /> 1 UEf3L0 COun'�7 ei.C'Rk.� Q r <br /> 2pp�5 ion" sr. <br /> 1003 <br /> I I I'I II I III I II II III I I I I II I I I I B3. Service Type ❑Priority Mail Express® <br /> ❑Adult Signature ❑Registered MailT'" <br /> ❑e ll Slgnature Restricted Delivery ❑Rad Male egistared Mall Restricted <br /> e y <br /> 9590 9402 5695 9346 6383 92 Certified Mail Restricted Delivery ❑Return Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(Fransfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation— <br /> '4ail ❑Signature Confirmation <br /> 7 019 29700000 8239 2216 all Restricted Delivery Restricted Delivery <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br />