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CERTIFIED ® RECEIPT <br /> COMPLETE •N COMPLETE THIS SECTIONON DELIVERY <br /> r Domestic Mail • <br /> n <br /> 3 For ■ Complete items 1,2,and 3.Also complete A. nat— <br /> 3at item 4 if Restricted Delivery is desired. ❑Agent <br /> elivery <br /> • I C A Ainformation,visit our • L U S ■ Print your name and address on the reverse X Addressee <br /> r •� so that we can return the card to you.r y B. ReGaacd by(Printed Name) C. Date f livery <br /> 3 Postage: $0.465 ■ Attach this card to the back of the mailpiece, ✓ l� <br /> a <br /> ° or on the front if space permits. f <br /> Certified Fee: $3.300 1. Article Addressed to: D. Is delivery address different from item es <br /> :3 Return Receipt Fee: $2.700 uk If YES,enter delivery address below: <br /> (E No <br /> � F <br /> (E Total Postage & Fees: $6.465 Jerry Johnston <br /> u <br /> 13800 Hwy. 24 <br /> R Total Postage&Fees L$ Divide, CO 80814 <br /> u <br /> Sent o 3. Service Type <br /> t ❑Certified Mails ❑Priority Mail Express'" <br /> orPOBxNo.o:,"" Jerry Johnston .......................... � ❑Registered ❑Return Receipt for Merchandise <br /> or PO Box No. 13800 Hwy.24 El Insured Mail ❑Collect on Delivery <br /> Divide, CO 80814 ''"""."""-" - <br /> i 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> PS Form 31300,July 2014 See Reverse for Instructions 2. Article Number 7 014 212 0 0001 8040 0064 <br /> (Transfer from service label) <br /> PS Form 3811,July 2013 Domestic Return Receipt <br /> U.S. Postal Service'" <br /> o UNITED STATES POSTAL SERVICE First-Class Mail <br /> CERTIFIED RECEIPT Postage&Fees Paid <br /> z' Domestic Mail Only USPS <br /> -0 111111 Permit No.G-10 <br /> C] <br /> o T= "_ • Sender: Please print your name, address, and ZIP+41 in this box• <br /> m Postage: $0.465 <br /> Certified Fee: $3.300 <br /> o Return Receipt Fee: $2.700 <br /> o (E State of CO - Dept. of Natural Resources <br /> o F Division of Reclamation, Mining &Safety <br /> o (E Total Postage & Fees: $6.465 MINERALS <br /> ru 1313 Sherman Street, Room 215 <br /> Total Postage&Fees <br /> ru <br /> r-1 Denver, CO 80203 M-1982-044 <br /> Sent To 34130000 30-day Grace Iketter <br /> � sireera:iPi.-tio.:-- Jerry Johnston TC1 WHE AJW <br /> C] or Po Box No. 13800 Hwy. 24 <br /> r` <br /> cm;srare,z�P+a Divide,CO 80814 -""""'""""'"'-----'- <br />