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RECEIVED <br />AUG 0 1 2012 <br />Division of Reclamation, <br />Mining and Safety <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 mallpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />John Patrick <br />16038 Clover Ln <br />Dubuque, IA 52002 <br />PS Form 3811, February 2004 <br />UNITED STAT �I " i.., , <br />SENDER: COMPLETE THIS SECTION <br />• Sender: Please print your name, address, and ZIP +min this box • <br />M A L L OF I:ULORADO <br />DEPARTMENT OF NATURAL RESOURCES <br />DIVISION OF RECLAMATION, MINING & SAFETY <br />1313 SHERMAN STREET, SUITE 215 <br />DENVER, CO 80203 <br />C199 <br />SL -4 Notification Letter <br />. <br />A. Si.natu <br />2. Article Number 7009 2820 0003 5700 6502 <br />(Transfer from service label) <br />Domestic Return Receipt <br />3. Service Type <br />❑ Certified Mall <br />❑ Registered <br />❑ Insured Mail <br />4. Restricted Delivery? (Extra Fee) <br />❑ Agent <br />❑ Addressee <br />C. Date of Delivery <br />Is delivery address different from item 1? ❑ Yes <br />If YES, bnter delivery address below: ❑ No <br />❑ Express Mall <br />❑ Return Receipt for Merchandise <br />❑ C.O.D. <br />❑ Yes <br />102595 -02 -M -1540 <br />