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d SENDER: <br />:o ■ Complete items 1 and/or 2 for additional services. <br />• ■Complete items 3, 4a, and 4b. <br />•Print your name and address on the reverse of this form so that we can retum this <br />• card to you. <br />■Attach this form to the front of the mailpiece, or on the back if space does not <br />E permit. <br />• ■ Write'Retum Receipt Requested' on the mailpiece below the article number. <br />•The Retum Receipt will show to whom the article was delivered and the date <br />delivered. <br />v • 3. Article Addressed to: <br />d <br />a <br />0 <br />v <br />cc <br />UNITED STATES POSTAL SERVICE <br />5. Received By: Print Name) <br />Bowie Resources, LLC <br />P.O. 483 <br />Paonia, Co 81428 <br />6. Signature: ( A r _t ee or Agent <br />PS Form 3811, Dr7 - ber 1994 <br />C- 1996 -083 <br />CV2013 -001 <br />Notice and Order to Pay Fixed Penalty <br />SLB /AHH <br />7019 2820 0003 5701 2374 <br />?.bate of Delivery <br />I also wish to receive the <br />following services (for an <br />extra fee): <br />1. ❑ Addressee's Address <br />2. ❑ Restricted Delivery <br />Consult postmaster for fee. <br />Vb. Service Type <br />❑ Registered ❑ Certified <br />❑ Express Mail ❑ Insured <br />❑ Retum Receipt for Merchandise ❑ COD <br />8. Addressee's Address (Only if requested <br />and fee is paid) <br />Domestic Return Receipt <br />First -Class Mail <br />Postage & Fees Paid <br />LISPS <br />Permit No. G -10 <br />• Print your name, address, and ZIP Code in 11 vElb <br />State of Colorado APR 0 8 2013 <br />Department of Natural Resources DiviS�o� of <br />Division Sherma St eet, Room Mining &Safety M�� S �i <br />�Y <br />Denver, CO 80203 Spec <br />