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¦ Complete items 1, 2, and 3. A150 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 mallpiece, <br />the front if space permits. _ <br />1. Article Addressed to: <br />A "ature . ,/2 Agent <br />? Printed Name) C• e?oT <br />B. ceiv d by ( <br />0 as <br />D. Is delivery address different from Rem 1 0 No <br />If YES, enter delivery address below: <br />Lake County A <br />P.o. Box 917 <br />Leadville, Colorado 80461 3. sen,IceTyPe <br />I?dCertifled Mail 0 Express Mail <br />i <br />l <br />n AmN is Number <br />? Registered ? Retum Receipt for Merahand se <br />0 Insured Mail 0 C.O.D. Yes <br />4. Restricted Delivery? (Extra Fee) 13 7010 0290 0002 0735 8864 <br />102595-02-M-1540 . <br />PS Form 3811, February 2004 <br />Domestic Return Receipt <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 />Lake County Conservation District <br />A. Sign re p Agent <br />X ? Addressee <br />Race ly by (Printed Name) Date of Delivery <br />B <br />. <br />D. Is delivery address different from Rem 1? ? Yes <br />0 No <br />If YES, enter delivery address below: <br />P.O. Box 1287 3. service Type <br />Leadville, Colorado 80461 a((c;artiffed Mail 0 Express mail <br />0 Retum Receipt for merchandise <br /> <br />2. Article Number <br />(transfer from service labeq <br />PS Form 3811, February 2004 <br />0 Registered <br />0 Insured Mail 0 c.O.D. <br />4. Restricted Delivery? (Extra Fee ?? Yom-- <br />_--- 0735 8871 <br />701D 0-290 0002 <br />102595-02-M-1540 <br />Domestic Return Receipt