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~. ~_4~6 876 9~9 <br />c°~f Receipt o~ <br />° ~ C~~i~d Mail <br />co - <br />O No Insurance Coverage Provided <br />~ -uD1~_" Do not use for International Mail <br />ISee Reversal <br /> son. ~o;WV DEPT OF ENERGY <br />~ DIV S ON F I <br /> $Veel antl Nc <br />~~!!~p 161 WA H T ' <br />"t P 0 . Slate an0 ZIP Coae <br />~' CHARL N <br />~ Postage <br /> <br /> Ce~liliea Fee <br /> $p¢cia4Delrvpry FeC <br />E Reso¢¢tl Delweiy Fee <br /> <br />~ flews Aecepr $now~ng <br /> a WnGm 8 base Delne~etl <br />~ Remm ece~pi Snowing to WPOT, <br />f Dale. 0 AUtl~essee's AUtlress <br />~ rOrALlPoslage <br />r 8 Fees, <br />J Postmark Di Dale <br /> <br /> <br />LS <br />~ SENDER: <br />v .Complete items 1 ardor 21ar additional services. <br />I also Wish to reCBIVe th0 <br />a .Complete items 3, aa, and ab. following services (for an <br />~ ' • punt your name end address an the reverse of Ihia tone so Ihal we wn return this extra fes): <br /> <br />j raid 1D yDa. <br />lAtlach Ihi9 tone to the hoot o1 the maflpiace, or on the back it spate doa9 not <br />~, ^ Addre55e9'S Address Y <br />°- <br />N •Wntel'Relum Receipt Requesfetl'on the mailpiete below the a nt<le number. 2. ^ Restricted DBIivwA y <br />`L, r .The Return Receipt will show t0 whom the adide was delivered end the date <br />~ olafivered. ~ Consult postmaster for tee. <br />o <br />3. Article Addressed to: <br />4a. Article Number m <br />d <br />m <br />WEST VIRGINIA DEPT OF ENERGY Z 416 876 909 ~ <br />g <br />E DIVISION OF MIidES & MINERALS 4b. Service Type ~ <br /> ^ Registered CA Certified ~ <br /> 1615 WASHINGTON STREET EAST a <br /> CHARLESTON WV 25311 ^ Express Meil ^ Insured S <br />w <br /> ^ Return Receipt for Merchandise ^ COD <br />~ 7. Date of Delivery <br /> <br /> <br /> 5. Received By: (Print Name) B. Addressee's Address (Only!/ requested ~ <br /> and lee is paid/ _ <br /> -~ ~ <br />~ 6. Signal <br />r •X <br />A <br />PS Form <br />