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Division of Minerals and <br />T ~~ ~F <br />C~UV ~2Y ~ <br />ALZIAC.~tJZ' P~fLT~' <br />OW tJ~12S <br />CtN.iv~sla-~ pG~C1CaZ~ <br />~f•~tr *k N-l~'l8-lgz~ GN-1 <br />I <br /><i <br />^ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />^ Print your name and address on the reverse <br />so that we can return the card to you. <br />^ Attach this card to the back of the mailpiece, <br />or on the front if space permits, <br />A. <br />~ ^ Agent <br />1. Article Addressed to: <br />~O`!Gti J. ~t~v~~ <br />B. ~Eeived~(PnntedlVame) C. Date of Delivery M1t <br />D. Is delivery address ditlerent from Rem 17 ^ Yes <br />Ii VES, enter delivery adtlress below: ^ No <br />Po F.~x1 ~~o ~~ <br />1~,;~)~ V iST~ . C',l~ 3. Service TYpe <br />44--~~ ~ pl iertified Mali Q E,cpress iviaii <br />~~ ~ ^ Registered ^ Return Receipt for Merchandise <br />^ Insured Mail ^ C.O.D. <br />4. Aestncted Delivery? (Extra Fee) ^ Yes <br />2. Article Number y /{ <br />((renster imm servito ladeq '~/~~ Q7J~O Q~ I ~~4 1 ~~ I~n4, <br />PS Forrn 3811, August 2001 Domestic Retum Receipt 102595-02-M-0935 <br />, .- <br />• Complete items 7, 2, and 3. Also wmplete <br />item 4 if Restricted Delivery is desired. <br />^ Print your name and address on the reverse <br />so that we can return the card to you. <br />^ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br /> <br /> <br />A. Sig <br />X ^ Agent <br />Addressee <br />. Received by (Printed Name) Dat~~~~ <br />D. Is delivery atldress diRerent from Rem 17 ^ Yes <br />If VES, enter delivery address below: ^ No <br />17Q~1~,'~ C(~ 3 a. service rypa ,1 <br />];] Certified Mail ^ Express Mail <br />^ Registered O Return Recept for Merchandise °, <br />^ Insured Mail ^ C.O.O. <br />4. Restdcted Delivery? (Exaa Feel ^ Yes <br />2. Article Number ~., <br />(transfer hom service labep -'~~1 n~itGl~ o~~j~ -'C~-~ ~~~:Jrj <br />PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-0e35 <br />t. Article Addressed to: y~~,^~ ~~r <br />~~717 (,I~t~p l-t..v-~~~ <br />133 Set~ty~ ST, ~ <br />~o`~ <br />