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<br />M1 <br />4 SENDER: ~ <br />p Complete Items 1 and/or 2 for addnionel cervices. <br />' m • Complete items 3, entl be 8 b. ' <br />' p • print your hems and eddrsce on the revsrce of this form so met we een <br />ntum this card to You. <br />` • Attach chic lorm to the Iron[ o/ the meilplecc, or on tM b•cM if specs <br />does not permit. <br />p • Wme"Hetum fleceipt Paeueetetl"on the meilpi•Ge below the chicle number <br />•t. <br />• The datum Haceipt will chow to whom tM artld• wee delivered end me detQ <br />` O tlelivsred. ' ~ <br />O <br /> <br />i also' wish to receive the <br />following services Ifor'en exva <br />feel: <br />1. ^ Addressee's Addreae <br />2, Q Restricted Delivery <br />t Y . Article Addressed to: <br />3 ,L Me. Anicl9 Numb/er "' (, <br />Z <br />i 1/ <br />~~ <br />/fp •.1~oSC eOr.N1/-y 7 <br />a Y <br /> <br />G~Q~~ ,~ /J <br />/~yo~pf~Pt( 4b. Service Type <br />Registered ^Inaured <br />^ <br />N , <br />L!•Gertified ^ COD <br />w ~ ~ C ~ ^ E><prass Me' eturn <br />;C O s03P <br />C ~ 7. Date o Oe ry <br />'a t <br />5. Si re ( ress 8. Addr e's r~q <br />~ and a is psi U <br />'' ~199d <br />R ign a (Age t) Z' <br />I~ ~' <br />> orm 11, December 1991 aus.upo:lalc~-.saxals DOMES <br />p <br />RECEIVED <br />DEC 0 9 1994 <br />~~ <br />for <br />F <br />I <br />m <br />Z <br />y <br />~• <br />V' <br />O' <br />Q ~ <br />l <br />R <br />oy <br />5, <br />7 <br />o~ <br />C+ <br />RECEIPT ~ <br />Division of Minerals ~ Geology <br />