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.- <br />~' <br />~~ ti ~J <br />roof of receipt by Custer._county clerk o£ <br />add` ~ onal items to packet for 112 Conversion <br />Hardship Lode <br />R~~`~f~~ir.~ ~~' ~~~j~~a <br />L DEC <br />~ 4 zs s ~ 2 <br />~ ~ , ~ ~~ ~~ ~~ o~~ts,~„ ~ zoo e ~ zoos <br />Minin u.,~fl ~D.D~on ao ~kj <br />9 and Safefy <br />~! M D,;,_ Clr <br />~'. ~ RN~S !R(~9aR°~Saf err <br />(,ew~~i~Urt ~' { ~' <br />_- <br />. , <br />^ Complete items 1, 2, and 3. Also complete a Signature ~ <br />item 4 if Restdcted Delivery is desired. • • ~ j~ ^ Agent <br />^ Print your name and address on the reverse ~i~/, 'G~~rii~, Z%~ L ' ^ Addressee <br />5o that W0 Can return the card to you. B. Receiv by (Punted Name) C. Date of D$livgry <br />^ Attach this card to the back o} the mailpiece, `!CL _ <br />or on the front if space permits. I <br />D. Is delivery address ditferenC trnm item 1? ^ Yes <br />1. Article Addressed to'. If YES, enter delivery address below: ^ No <br />Custer Cty Clerk/Recorder <br />205 S. 6th St <br />Westcliffe, CO 81252 <br />3. Service Type <br />Certified Mail ^ Express Mait <br />^ Registered (~ Retum Receipt tar Merchandise <br />^ Insured Mail ^ C.O.D. <br />4. Restricted Delivery? (Extra Fee} ^ yes <br />z. AnlaleNumber 7003 1410 OH03 14_7&_ 0_271_ <br />((2rtsfer Irom service fa6elJ <br />PS Form 3811, February 2CD4 Domestic Rersrn Receipt ~ tezsas-oz-ho-ts+a •, <br />