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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> • Complete items 1,2,and 3. A. Signature <br /> • Print your name and address on the reverse X A ' / 7 0 Agent <br /> so that we can return the card to you. _ 0 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 /> ;Ii rf-. "-ir .0 7 1? ❑Yes <br /> Steve Williams =S,en er de Ivey ad•ress•:ow: 0 No <br /> Washington County <br /> 11920 Co Rd. CC ANIS 23 2024 <br /> P O Box 32 _ <br /> Anton.CO 80801 Colorado Division of Reclamation, <br /> M-1994-077 BFB _ Mining and Safety <br /> 11111111111111111111111111111111111 3. Service Type <br /> /3 Adult Signature 0 Priority Mail Express® <br /> ❑Registered MaiITM <br /> ❑Adult Signature Restricted Delivery 0 R Istered Mall Restricted <br /> 0 CeMail® Deliv <br /> 9590 9402 4401 8248 9094 38 o Certifieded Mai Restricted Delivery 0 Receipt for <br /> ❑Collect on Delivery Merchandise <br /> 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation <br /> n Insured Mail 0 Signature Confirmation <br /> 7018 2290 0001 8923 5166 <br /> sured Mall Restricted Delivery <br /> ver$500) Restricted Delivery <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br />