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<br />RECEIVED <br />UcC 16 1SSE3 <br />' Division of tAirrerals & Geoloy; <br />d <br />a SENDER: <br />•COmplete items 1 anrUor 2 for ae7ilional servitea. I also wish to receive the <br />m •Complete ilema 3. 4a, ana 4E, tOIIOWIng SBfVICeS (fOr an <br />~ • Pnm your name and aaorass on the reverse of thu farm u that we can return stria extra !ee): ' <br /> <br />j carC to you. <br />•Attach this loim ro the hoot al the mailpiece, or oe the Earle it apace tloes not <br />i <br />1. ^ Addre5see's Address ¢d <br />u <br />I ~ <br />m perm <br />t. <br />• Wnte"Aetum Receipt Repuesretl'on tna mailyeca Eelow the aniUe <br />number. <br />2. ~ Resiriaad DBIIVery ~ <br />y <br /> • The Relum Receipt Mill show to whom the artida was tlelivered ane the tlare G <br />~ eeliverea. Consult poshnaster for lea. .~ <br />0 <br />a <br />3. Article Addressed to: <br />4a. Article Number <br />v <br />d Lake ~p~n+y Bcarcl ~~ ~.~,mt<s,~ ~ P ~o> l~ol 5yy <br />E Q <br />X ~~ <br />P0 4b. Service Type <br />ist <br />^ Re <br />d C <br />rtifi <br />d 3 <br />~ <br /> <br />u . <br />J <br />g <br />ere <br />e <br />e <br /> <br />vi <br />( ~ l I , <br />~(?C v I 1 e <br />~~ <br />^ Express Mail ^ Insured to <br />& <br />o / ~Relum ReceipUar Merchandise p COD <br /> ~n~(, ~ 7. Da ~__Delivery ~ <br />~ a <br />= K o <br /> T <br />~ 5. Received By: (Pdnt Name) 8. Addressee's Address (Only it requested ~ <br />to and fee is paid) ~ <br /> f- <br />~ 6. Sign dd sae or Agent) 7 <br /> <br />T <br />~ <br />,, <br />X ~~~ <br />N <br />_ <br />PS Fonn 3811. December 7994 i <br />Domestic Return Receipt <br />N <br />m <br />m <br />Q <br />Q <br />O <br />O <br />m <br />CJ <br />E <br />0 <br />Vl <br />o. <br />P :,t77 6~1, `_44 <br />US Postal Service <br />Receipt for Certified Maii <br />No Insurance Coverage Provided. <br />Do not use for International Mail ISee ravemel <br />Sent to <br />LA.ke C ttnfy ~. ~~nmi5 +Cnrr <br />Street d Number ' <br />°0.3 ~b <br />Post OKca, Stare, 8 ZIP CoEe <br />i_andv.l CU <br />Be41cl <br />Postage $ ,S-~ <br />CeNfed Fee ~ ~ <br />Speaal Delivery Fee <br />RestngeE Delivery Fee <br />Relum Retelpt Showing to <br />Whom 8 Dale Delivered /~ <br />. /v <br />RGAxn RftPgl $hpvvg to Wham, <br />Oale, 8 AdGeuees Aoareas <br />TOTAL Posrage d Fees ~ ~ ~L~ <br />Pos~mark or Oatap~p <br />{~~ Q '~ <br />tOnu <br /> <br />