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UNITED STATES POSTAL SERVICE <br />First -Class Mail <br />Postage & Fees Paid <br />LISPS <br />Permit No. G -10 <br />• Sender: Please print your name, address, and ZIP +4 in this box • <br />STATE OF COLORADO <br />DEPARTMENT OF NATURAL RESOURCES <br />DIVISION OF RECLAMATION, MINING & SAFETY <br />1313 SHERMAN STREET, SUITE 215 <br />DENVER <br />` MLT, sb1 <br />kilo n 1 M3 C -1981 -008 <br />�..,�.�yy [ p SL -14, Withdrawal Letter <br />llf'4 '' uij% sF il`fl'tj #l�r:l s; ; <br />f <br />7 <br />• Complete Items 1, 2, and 3. Also complete <br />• Print your name and address Is on t he rreversl <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 />Board of County Commissioners <br />Montrose County <br />161 S Townsend Ave. <br />Montrose, CO 81401 <br />A. Signature <br />1' ��. ��.���1,L.C.2 ❑Agent <br />❑ dre; <br />B. Received X(Pr/ntedNamel ran r .n .: <br />D. Is d$livery address different from Item 1? ❑ Ye; <br />If YES, enter delivery address below: ❑ No <br />s. berwce Type <br />❑ Certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />a- Rasb4MnA ri-m ,._.....- - <br />a UWU rvumoer — -- <br />(Transfer from service label) 7 010 1060 0001 0 9 3 6 2103 <br />` PS Form 3$11, February 2004 Domestic RetuReturnReceipt <br />102595.02 -M -1540 <br />