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I <br />UNITED STATES POSTAL SERVICE <br />a, <br />• Sender: Please print your name, address, and ZIP"tfis box • <br />r <br />State of Colorado <br />Department of Natural Resources <br />Division of Reclamation, Mining & Safety <br />1313 Sherman Street, Suite 215 <br />Denver, CO 80203 Spec Am e&b <br />File 6-12$7- <br />1-111 )JIM 11JI 1111111f trtlrJt.LitlttJttJJttJltt+J?J„i?J?i U.S. Postal ServiceT 1.1 <br />t Certified Mail Provides: Spec" Uji g'am'-•- <br />¦ Aigreceipt CERTIFIED MAIL,,., RECEIPT <br />1±1-=y -=y a (Domestic Only; No ¦ A unique identifier for your mail ce' ro Insurance ? . . , <br />¦ A record of delivery kept by the Postal service for two years <br />important Reminders: F>t S '?-i? 2 <br />¦ Certified Mail may ONLY be comIned with First-Class Mail®or Priority Mails. ' <br />¦ Certified Mail is not available for any class of international mail. p' Postage s " $0.44 <br />¦ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For f? $2.'s <br />5 <br />valuables, please consider Insured or Registered Mail 1 Ln postage* <br />rte;,' <br />¦ For an additional fee, a Return Receipt may be requested to rovide proof of -A$2,30 <br />p m <br />delivery. To obtain Return Receipt service, please complete and attach a Return Certified Fee_ <br />Receipt (PS Form 3811) to the article and add applicable postage to cover the r-3 (Endori Receipt Fee ? a t <br />fee. Endorse mailpiece "Return Receipt Requested'. To receive a fee waiver for C3 Return s $5 5 <br />a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is o Restrii <br />required. (Endore toge & Fees: <br />¦ For an additional fee, delivery may be restricted to the addressee or r-3 'Total, Pos <br />addressee's authorized agent. Advise the clerk or mark the mailpiece with the ` Total F, <br />endorsement "Restricted Delivery'. i <br />¦ If a postmark on the Certified Mail receipt is desired, please present the arti- . <br />cleat the post office for postmarking. If a postmark on the Certified Mail D^ i <br />receipt is not needed, detach and affix label with postage and mail. C3 Washington International Insurance Company <br />IMPORTANT: Save this receipt and present it when making an Inquiry. o I 475 N. Martingale Road, Suite 850 <br />Schaumburg Illinois 60173 <br />PS Form 3900, August 2006 (Reverse) PSN 7530-02-9047 ' <br />DRMS-1313 Sherman, Rm 2150011,. Denver, CO 80203 <br />PS F 0-m MO. August 2006 <br />See Reverse for 1? <br /> <br />¦ Complete items 1, 2, and 3. Also complete A. Sig ure <br />item 4 if Restricted Delivery'is desired. ? Agent <br />X <br />¦ Print your name and address on the reverse ? Addressee ' <br />sb that we can return the card to you. <br />¦ APach this card to the back of the mailpiece B. Rikelved by( Print Na e) C. Date of Delivery <br />, <br />cpon the front if space permits. <br /> <br />1. A cle Addressed to Is delivery address different from item 1? ? Yes <br /> If YES, enter delivery address below: ? No <br /> <br />I <br />Washington International Insurance Company <br />475 N. Martingale Road, Suite 850 <br />Schaumburg, Illinois 60173 3. Service Type <br /> WCertiffed Mail ? Express Mail <br /> ? Registered jdRetum Receipt for Merchandise ` <br /> ? Insured Mail ? C.O.D. <br /> 4. Restricted Delivery? (Extra Fee) ? Yes <br />2. Article Number <br />(rransferfrom service lab" 7209 2820 0003 5701 4781 <br />1PS Form 3811, F p. <br />ebNatFy 28Q4 V*wiestie ftwm !Ac--?-ipt g