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L.G. Everist, Inc. <br />PERMIT # M- 1999 -120 <br />PROOF OF DELIVERY - Adjoining owners <br />April 25, 2012 <br />1. Article Addressed to <br />2. Article Minter U <br />1 <br />Ms. Anna Verbeek <br />11400 WCR 14.5 <br />Fort Lupton, CO 80621 <br />1 <br />1 <br />� 2, <br />DeliveN* desired. <br />• Print your noble and address on the reverse <br />so that we can return the card to you. <br />• Attach this card to the back of the mallplece, <br />or on the front if space permits, <br />} } } } } Dbrt►iWo ItNum Receipt <br />Fort Lupton Sand and Gravel <br />SENDE Ci)r.1F (.1.:T TH!:; s &CrION <br />N LIEL 1FI1 <br />D. Is delivery address different from !tarsi 17 0 its <br />If YES, enter delivery address below: 0 No <br />& Service Type <br />Mortified Mel O Express Meg <br />0 Registered & Ret rn Receipt for Merdwdise <br />0 Insured Mall 0 C.O.D. <br />4. Restricted Delivery? (Extra Fey) 0 Yes <br />7010 1670 0001 7818 2078 <br />D Nam <br />0 Addrseses <br />102605. 02444510 <br />9 <br />