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^ Complete Rems 1, 2, and 3. Also complete <br />I Rem 4 R Restricted Delivery is desired. <br />^ Print your name and address on the reverse <br />I so that we can return [he card to you. <br />I ^ Attach this card to the back of the mailplece, <br />or on the front it space permits. <br />1. Article Addressed to: <br />~ Jefferson Conservation District <br />I Sally Lobel, District Mgr. <br />655 Parfet St., Rm E-300 <br />Lakewood, CO 80215-5517 <br />A signnature f <br />B. ReceNetl by (Printed Name) ~ Cr, Date of Deli <br />D. Is delNery address diRereM from Rem 11 ^ Yes <br />R VES, emer delivery adtlress below: ^ No <br />3. Service Type <br />CeNfied Mail ^ Express Mall <br />Registered ^ Retum Receipt for Merchantllse <br />^ Insured Mall ^ C.O.D. <br />4. ResMCtetl Deliveryt (Extra Fee) ^ Yes <br />z. ArpcieNumber 7004 2510 0004 8248 4035 <br />(transfer morn serv/ce laba~ <br />PS Form 3811, February 2004 Domestic Retum Receipt tozsaso2-n+-tsa <br />^ Complete Rams 1, 2, and 3. Also complete <br />Rem 4'rf Restricted Delivery is desired. <br />^ Print your name antl address on the reverse <br />so that we can retum the card to you. <br />^ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />Board of County Commissioners <br />Gilpin County <br />203 Eureka Street <br />Central City, CO 80427 <br />2. Article Number <br />A S' natwe <br />X Agent <br />^ Addressee <br />B. ReceNed by (Pnnted Name) C. Date of Delivery <br />D. Is delivery address diRerent M1om Rem 11 U Vas <br />R VES, emer delivery address below: ^ No <br />3. y~Se~f~'~ce Type <br />C <br />ertiped Map <br />l&. ^ Fxpresv Mail <br />^ Registered ^ Retum Receipt for Merchandise- <br />^ Insured Mail ^ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ^ Yes <br />7004 2510 0004 8298 4042 <br />PS Form 3811, February 2004 Domestic Retum Receipt <br />tozsssuz-M-tsao <br />