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<br />• SENDER: Complete items 1, 2, 3 and 4. <br />Put y0a atldress in the "RETURN TO" spacq~On the <br />a <br />•Feilure to tlo this wdl prevenrtPn card from <br />revxrs sitl <br />being raturnetl to you. The return receipt lea~vill provitle <br />you [he name Ot the pwson tleliveretl to end the date 01 <br />tlalivery. For additional lea the following service are <br />available. Comult postmtlaer for tea end check boxlal <br />for sarvicalsl rspuatad. <br />1. W Show to whom, date end atldras of delivery. <br />Z. ^ Ratrictatl Delivery. <br />3. Article AdOresietl [O: <br />Trinidad Basin Mimm~g <br />P.O. Box 783 <br />Trinidad, Colorado 81082 <br />q. Type o1 Service: Article Number <br />lc7 Registered O Insured <br />C p 652 674 420 <br />~ <br />] Certified ^ COD <br />O Express Mail <br />Always obtain slgnalure of addressee or agent and <br />DATE DELIVERED. <br />5. Signature - A aaee~ <br />y <br />l <br />~~ <br />X <br />~ <br />2 <br />6. Signature -Agent <br />x <br />]. Date OI Delivery <br /> <br />B. Adtlrasseei Atltlress (ONL T'! regverl o [C Aa <br />T <br />'3 <br />J <br />c <br />b <br />m <br />u <br />`4i <br />r l ,P 652 674 42U <br />o RECEIPT FOR CERTIFIED MAIL <br />NO INSURANCE COVERAGE PROVIDED <br />NOT FOR INTERNATIONAL MAIL <br />(n <br />tp ~ (See Reverse) <br />~ ~~4~idad Basin Mini <br />veetaadDN.p.783 <br />'• .O„ S(a6a eCnd ZIP Code <br />ai,'' rini~ad, Colorado 81082 <br />~O Postage 6 <br />mid <br />may Cartlllr,d Fee <br />M <br />N Special Dallvery Fee <br />~E Reetrlcted Dallvery Fee <br />~ toewhn Rand Dete Delivered '~b <br />RI tl <br />Lo Retum mcelpt showing to whom, <br />Dale, and gtldress of Delive <br />~. <br />NLL TOTAL Posteg~ F S <br />M <br />Postmark or Dete <br />t <br />. r:•" <br />~LL f <br />Jv, <br />~a <br />~' ------ <br />