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M SENDER: <br />9 <br />•Complete items 1 and/or 2 for additional services. <br />in •Complete items 3, 4a, and 4b. <br />a • Print your name and address on the reverse of this form so that we can return this <br />E card to you. <br />•Attach this form to the front of the mailpiece, or on the back if space does not <br />E permit. <br />, ■ Write'Retum Receipt Requested' on the mailpiece below the article number. <br />. •The Return Receipt will show to whom the article waedelivered and the date <br />C delivered. <br />m • 3. Article Addressed to: <br />a <br />0 <br />0 <br />David and Terri Andrews ! <br />P.O Box 523 <br />Norwood, Colorado 81423 <br />5. Repeived By: (Pn N e) <br />Ler ,c1 <br />W <br />cc <br />• 6. Signature: (Address a or Agent I <br />0 X / ' s r (1 /F�'C .-ze <br />— PS Form 3811, December 199 <br />I also wish to receive the <br />following services (for an <br />extra fee): <br />1. ❑ Addressee's Address <br />2. ❑ Restricted Delivery <br />Consult postmaster for fee. <br />7008 3230 0002 7252 5370 <br />4b. Service Type <br />❑ Registered ❑ <br />❑ Express Mail , , ❑ <br />❑ Return ReceiVtfof Merchandi��b <br />7. Date of Delivery <br />P <br />8. Addressee's Ad (Only ifrgv <br />and fee is paid) <br />Certified <br />Insured <br />COD <br />Domestic Return Receipt <br />RECEIVID <br />APR 272012 <br />Division of Reclamation, <br />Mining and Safety <br />PLC <br />c 99 <br />�U" 3 <br />