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~ ~ III IIIIIIIIIilillll <br /> <br />Ir' I G ,I v. V,I <br />I! :_ <br /> <br />~IVision of Minerals & Geology <br />~. <br />a, <br />a <br />m <br />N <br />u <br />d <br />t <br />0 <br />v <br />a <br />E <br />N <br />0 <br />0 <br />a <br />z <br />7 <br />w <br />5 <br />0 <br />a <br />•Cnnplete items t aWlor 2 for adtliGOnal services. ~ I also wish to receive the <br />•Camplete items 7, 4a, and do. 1DIIDWIng aefVlCBS (IOr an <br />•Pdm your name and adtlress on Ne reverse of this form so Thal we can return this eMra fee : ' <br />~ <br />card to you. o <br />u <br />•Atlach Ihi9 form to the hoot of the mailpieoo. or on the oark it space does not t. Q Addfe55ee'S Address <br />pemut. <br />•Wnte'Ferum Recerq Requested' on the mailpreca below the artrcfe number. <br />2. ^ RBSiriCted Dalfvery <br />(n <br />•The Relum Pecaipt writ Show to wham the artiUa was tlaliveretl antl the tlate <br />deliveree. Consult postmaster for fee. a <br />"m <br />Arecle Adoressetl to: <br />Lake Cor~nfy Bca rc~ C~F CCrrlrnl <br />P.o.3~x 9~~- <br />Leac(~ ~ l l~ , CO <br />~~~~~ <br />X ~-~~ZO./~i e <br />PS Form 3811, December <br />m <br />m <br />O <br />Q <br />O <br />O <br />m <br />E <br />0 <br />u) <br />a <br />P Ll7i .p1 X44 <br />US Postal Service <br />Receipt for Certified Mail <br />No Insurance Coverage Provided. <br />Do nor use for Inramatinnal AA~iI /Cna m~o.cal <br />Sent to <br />Lemke Ccunf y Cd. <br />l.d:,,.n~ss;c.,e~ <br />Street 6 Num6m ' <br />P 0. ~ Sb <br />Past Ofl¢e, gate, 8 ZIP Code <br />G~-r~dv.l c CJ <br />6e41,;1 <br />Postage $ S-~ <br />J <br />Certified Fee ~ ~ <br />Speoal Delivery Fee <br />Restncted Delivery Fee <br />Relum Recapl Showin9lo <br />KTOm 6 Dale Deliveretl <br />. rL <br />Realm Recept Stwwrq to Whom. <br />Dale. 8 Atl~estee's AONess <br />TOTAL Postage S Fees $ ~O[l <br />Postmark or Data <br />GEC 0 9 <br />1dnr: <br />4a. Article Number v <br />oi sky <br />P ~o~ t <br />,~ <br />4b. Service Type <br />u <br />^ RegisteredCertified <br />^ Express Mail ^ Insured c <br /> <br />~ReNm .Receipt far Merchandise ^ COD N <br />7. Da ~__belivery <br /> i. <br />8. Addressee's Address (Only i/ requested ~ <br />and lee is paid) t <br /> <br />rn <br /> <br />