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ice = <br />N`r 4retJc <br />?v <br />.cue " <br />• Sender: Please print your name, address, and ZIP+4 in this box • <br />STATE OF COLORADO <br />DEPARTMENT OF NATURAL RESOURCES <br />DIVISION OF RECLAMATION, MINING & SAFETY <br />1313 SHERMAN STREET, SUITE 215 <br />CO 80203 - <br />Spec.JAH <br />File #fn-psa-)?y9 <br />Q?? q -17-10 <br /> <br />A. <br />X <br />rlltttirlttltltr <br />M_ (Domestic Mail Only; No Insurance Coverage Provided) <br />For delivery information visit our website at o <br />r-q <br />M Postage: <br />Certified Fee: $1.80 <br />E3 Reta Return Receipt Fe_ p6c T a <br />° (Endorsee <br />,0? $5. <br />° Restricts Total Postage & Fees cS'e <br />° (Endorser <br />ru ° Total Postage & Fees $ \ ? <br />rrl I <br />-- - <br />° Jacque Goemm a-nd <br />° 3°fieeet,Apt7.QF;--------- L. Otto Goemmer <br />or PO Box No. P.O. Box 165 <br />-------------------------- <br />Crry, state, ziP+4 La Veta, Co 81055 <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 />1. Article Addressed to: <br />Jacque Goemmer and <br />L. Otto Goemmer <br />P.O. Box 165 <br />La Veta, Co 81055 <br />UNITED STATEZ-PQy4 <br />k4 E <br />T_ AW <br />ge, log, <br />:'rttiltllltatttllttiff ltiltltf,tittllt <br />Certified Mail Provides: <br />¦ A mailing receipt Spec. ¦ A unique identifier for your mailpiece <br />¦ A record of delivery (ept by the Post a foIt2 <br />l ?q <br />Important Reminders: V&%,"* <br />¦ Certified Mail may ONLY be combined with First-Class Maile or Priority Mai <br />¦ Certified pail is not available for any class of international mail. <br />¦ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. R <br />valuables, please consider Insured or Registered Mail. <br />¦ For an additional fee, a Return Receipt may be requested to provide proof c <br />delivery. lb obtain Return Receipt service, please complete and attach a-Retur <br />Receipt (PS Form 3811) to the article and add applicable postage to cover th <br />fee. Endorse mailpiece "ReturnReceipt Requested". To receive a fee waiver fc <br />a duplicate return receipt, a USPSe postmark on your Certified Mail receipt i <br />required. <br />¦ For an additional fee, delivery may be restricted to the addressee < <br />addressee's authorized agent. Advise the clerk or mark the-mailpiece with th <br />endorsement "Restricted Delivery". <br />¦ If a postmark on the Certified Mail receipt is desired, please present the art <br />cle at the post office for postmarking. If a postmark on the Certified MF <br />receipt is not needed, detach and affix label with postage and mail. <br />IMPORTANT: Save this receipt and present it when making an inquiry. <br />PS Form 3800, August 2006 (Reverse) PSN 7530-02-000-9047 <br />DRMS•1313 Sherman, ism 215, Denver, W b02O3 <br />? <br />B. Ffeceived by (Printed Name) C. Date of Delivery <br />l ?-_ ., o I 16-Y-10' <br />D. Is delivery address different from Item 1? ,?., YY <br />If YES, enter delivery address below: t?No <br />3. Service Type <br />? Certified Mail ? Express Mail <br />? Registered ? Return Recelpt for Merchandise <br />? Insured Mail ? C.O.D. <br />4. Restricted Delivery? (ExVa Fee) ? Yes <br />2. Article Number _ <br />(Transfer from service fabeo 7007 3020 0001 6340 1543 <br />PS Form 3811, February 2004 Domestic Return Receipt 5 o2-nn t 540