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HomeMy WebLinkAbout20101843.tiff • CERTIFICATION RE: NOTIFICATION OF MINERAL INTEREST OWNERS AND LESSEES The undersigned Applicant certifies compliance with the provisions of C.R.S. § 24-65.5- 103(1), and in support thereof, states and certifies as follows: 1. That Applicant has provided notice, (a copy of which is attached hereto as Exhibit "A"), containing the time and place of the initial public hearing on its application for Case Number U S (t - l f CO , the nature of the initial public hearing, the legal description by section, township and range of the property which is the subject of the initial public hearing, and the name of the applicant; 2. That said notice was provided thirty (30) days prior to the scheduled public hearing, that it was provided by certified mail, return receipt requested, or by a nationally recognized overnight courier; 3. That said Exhibit A includes the list of the names and addresses of the surface owners, mineral estate owners and lessees of mineral interests to whom the notice was sent, including those persons who have requested receipt of such notices, pursuant to C.R.S. § 24-65.5-103(3). APPLICANT: • Nr Col Cel (vlo� Tvc STATE OF //1 bra Jr) COUNTY OF Mn 9n t Subscribed and sworn to before me this 2 day of Au-just , 2000, by Robes} D. 14;rsckor n • \\N` • �. r A.1I . F,9s 1otary Public ccO.•SpTARy ,w Note: This Certification must be received by the Weld County Department'if kla nm i Services prior to or at the initial public hearing. If the Certification is not rec-ti1 - ••>, LIC .• % time, the hearing will be rescheduled to a later date, and Applicant must r-tt`'`; j,.••'�_ owners of mineral interests. w oF ��\`\,, My Commission Expires 08/25/2013 • 2010-1843 • Mineral/Leasehold Ownership Township 8 North, Range 62 West, 6th P.M. Section 35: All Bob E. White & Keitha E. White 3315 33rd Avenue Court Greeley, CO 80634 Grindstone Resources, LLC 5228 Lonetree Drive Loveland, CO 80537 Flatiron Energy Company, Inc. 6666 Gunpark Drive, Suite 200 Boulder, CO 80301 John S. Gibson Production, LLC P. O. Box 842 Ft. Morgan, CO 80701 • Daniel F. Brooks 3237 N. Forest Lakes Wichita, KS 67205 • .„--)) or wint= {{ July 2, 2010 Daniel F. Brooks 3237 N. Forest Lakes Wichita, KS 67205 Dear Daniel Brooks, On August 3, 2010 at 1:30 PM at 918 10th Street, Greeley, CO. 80631 a meeting of the Weld County Planning Commission will be held to hear an application from NE Colorado Cellular, Inc. d.b.a. Viaero Wireless for A Site Specific Development Plan and Use by Special Review Permit for a Non-1041 Major Facility of a Public Utility(330 foot wireless communication tower and related accessory buildings/structures) in the A (Agricultural) Zone District. • This facility will be located in Part of the SW ''A of the SW 1/4 of Section 35, T8N, R62W of the 6th P.M., Weld County, Colorado,Northeast of the intersection of CR 81 and CR 86. The parcel number is 0545 35 000003 and the case number is USR1750. This notification letter is being sent to you as a Mineral Interest Owner or Lessee. If you have any questions, you can call Bob Hirsekorn, the applicant's representative at 970-542- 3823. Sincerely, /, Robert Hirsekorn • We are where you are. 1224WPIatteAve Platte Ave Fort Morgan,CO 80701 Office 1.970.768.0000 Fax 1.970.867.3589 www.viaero.cor t• (l DTM • VVIi July 2, 2010 John S. Gibson Production, LLC P. O. Box 842 Ft. Morgan, CO 80701 Dear John Gibson Production, LLC, On August 3, 2010 at 1:30 PM at 918 10th Street, Greeley, CO. 80631 a meeting of the Weld County Planning Commission will be held to hear an application from NE Colorado Cellular, Inc. d.b.a. Viaero Wireless for A Site Specific Development Plan and Use by Special Review Permit for a Non-1041 Major Facility of a Public Utility(330 foot wireless communication tower and related accessory buildings/structures) in the A(Agricultural) Zone District. • This facility will be located in Part of the SW 'A of the SW 1/4 of Section 35,T8N, R62W of the 6th P.M., Weld County, Colorado,Northeast of the intersection of CR 81 and CR 86. The parcel number is 0545 35 000003 and the case number is USR1750. This notification letter is being sent to you as a Mineral Interest Owner or Lessee. If you have any questions, you can call Bob Hirsekorn, the applicant's representative at 970-542- 3823. Sincerely, - Robert Hirsekom • We are where you are. 1224W Platte Ave Fort Morgan, CO 80701 Office 1.970.768.0000 Fax 1.970.867.3589 www.viaero.coi + `fl orki . V'V16-�E-3� `1 July 2, 2010 Flatiron Energy Company, Inc. 6666 Gunpark Drive, Suite 200 Boulder, CO 80301 Dear Flatiron Energy Company, On August 3, 2010 at 1:30 PM at 918 10th Street, Greeley, CO. 80631 a meeting of the Weld County Planning Commission will be held to hear an application from NE Colorado Cellular, Inc. d.b.a. Viaero Wireless for A Site Specific Development Plan and Use by Special Review Permit for a Non-1041 Major Facility of a Public Utility (330 foot wireless communication tower and related accessory buildings/structures) in the A (Agricultural)Zone District. • This facility will be located in Part of the SW ''A of the SW 1/4 of Section 35, T8N, R62W of the 6th P.M., Weld County, Colorado,Northeast of the intersection of CR 81 and CR 86. The parcel number is 0545 35 000003 and the case number is USR1750. This notification letter is being sent to you as a Mineral Interest Owner or Lessee. If you have any questions, you can call Bob Hirsekom, the applicant's representative at 970-542- 3823. Sincerely, Robert Hirsekorn • We are where you are. 1224W Platte Ave • Fort Morgan,CO 80701 • OffiLe 1.970.768.0000 Fax 1.970.867.3589 www.viaero.co nOTM July 2, 2010 L7.4;II IU31'UiiG 5228 Lonetree Drive Loveland, CO 80537 Dear Grindstone Resources, LLC, On A1,g,1ot 3 201 n at 1•30 PTA at 01 8 1 nth Street C.reeler CO 80631 a meeting of the Weld County Planning Commission will be held to hear an application from NE Colorado Cellular, Inc. d.b.a. Viaero Wireless for A Site Specific Development Plan and Use by Special Review Permit for a Non-1041 Major Facility of a Public Utility(330 foot wireless communication tower and related accessory buildings/structures) in the A (Agricultural) Zone District. • This facility will be located in Part of the SW ''A of the SW 1/4 of Section 35, T8N, R62W of the 6th P.M., Weld County, Colorado, Northeast of the intersection of CR 81 and CR 86. The parcel number is 0545 35 000003 and the case number is USR1750. This notification letter is being sent to you as a Mineral Interest Owner or Lessee. If you have any questions, you can call Bob Hirsekom, the applicant's representative at 970-542- 3823. Sincerely, Robert Hirsekom • We are where you are. 1224 W Platte Ave - Fort Morgan,CO 80701 Office 1.970.768.0000 Fax 1.970.867.3589 - www.viaero.coi 1w t _fl TM • July 2, 2010 Bob E. White & Keitha E. White 3315 33rd Avenue Court Greeley, CO 80634 Dear Bob and Keitha White, On August 3, 2010 at 1:30 PM at 918 10th Street, Greeley, CO. 80631 a meeting of the Weld County Planning Commission will be held to hear an application from NE Colorado Cellular, Inc. d.b.a. Viaero Wireless for A Site Specific Development Plan and Use by Special Review Permit for a Non-1041 Major Facility of a Public Utility(330 foot wireless communication tower and related accessory buildings/structures) in the A (Agricultural) Zone District. • This facility will be located in Part of the SW '/4 of the SW 1/4 of Section 35, T8N, R62W of the 6th P.M., Weld County, Colorado,Northeast of the intersection of CR 81 and CR 86. The parcel number is 0545 35 000003 and the case number is USR1750. This notification letter is being sent to you as a Mineral Interest Owner or Lessee. If you have any questions, you can call Bob Hirsekom, the applicant's representative at 970-542- 3823. Sincerely, 1,_ R p . _ rC •ccrt tbrV1 Robert Hirsekorn • We are where you are. 1224 W Platte Ave Fort Morgan,CO 80701 Office 1.970.768.0000 > Fax 1.970.867.3589 a www.viaero.co • AFFIDAVIT OF INTEREST OWNERS MINERALS AND/OR SUBSURFACE Property Legal Description: , . r - - 5w''I JY4S S2C+10,�3c T8 W Property Legal Parcel Number: ar Y 53 `19-@fzQ_Q 3 STATE OF COLORADO ) ) ss. COUNTY OF WELD THE UNDERSIGNED, being first duly sworn, states that to the best of his or her knowledge, the attached list is a true and accurate list of the names and addresses of all mineral owners and lessees of mineral owners on or under the parcel of land being considered. The list shall be prepared from the real property records by a person qualified to do the task, and shall be current as of a date more than thirty (30) days pdor to the date the application is submitted to the Department of Planning Services. Note: Mineral Notification is in addition to that required by C.R.S. 24-65.5-102 through 104. • By: 0,4 1T /n��'^'�`� Title:�ir C4rlL5f Dv\ The foregoing instrument was subscribed and sworn to me this day of /la_q L s E , 20_IQ _ . WITNESS my hand and official seal. J My Commission Expires: R/ 25/ l3 ya x) Notar JET"... yp • JE • • •.d' c r 140TAR • Y °y PUBLIC • F...... OPP'- My Commission Expires 08/2512013 LIST OF MINERAL OWNERS AND MINERAL LEASES Subject Property: • Township 8 North, Range 62 West, 6th P.M. Section 35: All Hill Land Services, Inc., states that to the best of its knowledge the following is a true and accurate list of the names and addresses of the mineral owners and mineral leasehold owners having an interest in the Subject Property, based upon the real property records of Weld County, Colorado, as verified through June 24, 2010. A facsimile or photocopy of this list shall, for all purposes, be as valid as the original hereof. Dated this 3`d day of July, 2010. Hill Land Services, Inc. BY: elic.o fir G Wade R. Hill Mineral Interest Owners: Bob E. White & Keitha E. White • 3315 33''Avenue Court Greeley, CO 80634 Grindstone Resources, LLC 5228 Lonetree Drive Loveland, CO 80537 Flatiron Energy Company, Inc. 6666 Gunpark Drive, Suite 200 Boulder, CO 80301 John S. Gibson Production, LLC P. O. Box 842 Ft. Morgan, CO 80701 Daniel F. Brooks 3237 N. Forest Lakes Wichita, KS 67205 • 1 Hill Land Services,Inc. (970) 686-1194 8952 Gander Valley Lane Fax (970) 674-9120 Windsor, CO 80550 By acceptance and use of this list, the client and its agents agree to the following: • Hill Land Services, Inc. has agreed to prepare a listing of mineral estate owners for the Client only if the Client agrees that the liability of Hill Land Services, Inc. in connection with such services shall conclusively be limited to the amount paid by the Client to Hill Land Services, Inc. for such services. No warranty, express, implied or statutory, in connection with the accuracy, completeness or sufficiency of any such listing of mineral estate owners. In the event any such listing proves to be inaccurate, incomplete, insufficient or otherwise defective in any way whatsoever or for any reason whatsoever, the liability of Hill Land Services, Inc. shall never exceed the amount paid by Client to Hill Land Services, Inc. for such listing. Client hereby agrees to indemnify and hold Hill Land Services, Inc. harmless from and against all claims by all persons (including but not limited to Client) of whatever kind or character arising out of the preparation and use of each such listing of mineral estate owners, to the extent that such claims exceed the actual amount paid by Client to Hill Land Services, Inc. for such listing. • • 2 Hill Land Services,Inc. (970) 686-1194 8952 Gander Valley Lane Fax(970) 674-9120 Windsor, CO 80550 Case# USR-1750 • Name: Bob White do Viaero Wireless Proposed Project: USR for 330 foot wireless communication tower and related accessory buildings in the Agricultural Zone District Location: North of and adjacent to CR 86; North and East of the intersection of CR 86 and CR 81 Weld County Planning Services Planner: Chris Gathman ( 1555 N 17th Ave PC Hearing Date:Aug. 3, 2010 at 1:30 pm Greeley CO 80631 BOCC Hearing Date:Aug. 18, 2010 at 10:00 am ' O (970)353-6100 eM. 3540 COLORADO 35 • • Case# USR-1750 Name: Bob White do Viaero Wireless Proposed Project: USR for 330 foot wireless communication tower and related accessory buildings in the Agricultural Zone District Location: North of and adjacent to CR 86; North and East of the intersection of CR 86 and CR 81 /7 �,7 Weld County Planning Services Planner: Chris Gathman ( f, A• 1555 N 17th Ave PC Hearing Date:Aug.3, 2010 at 1:30 pm lamp e Greeley CO 80631 3540 BOCC Hearing Date:Aug. 18, 2010 at 10:00 am O (970)353-6100 eM. COLORADO 35 • • • C O Y N to to U L w N Y Y o lV C — L -C L 04 3▪ 2 Ln Ili L) C 'O C U ,-1 ,-1 L-1 ti r a .-I .-1 '-1 r-1 V M .-'1 L- CD l0 ID V1 l w 0 lD O OOOOn4OO O O O N O O u a D- 00 on DO o0 m co an CO ._ N C 0- v) a ") a a) C ai °p O H T Wt- a 0 0 0 0 0 o c@ • >� J J J J O J a G • F- 0 0 0 O W T 0 LLJ V) c ., v U V� V� U� V� Z J (D v co Y (D l7 l7 C7 V) W _U I-LI at m m m m 0 0 m 1.' y J C in D L C Y L C▪ C O C VI I- d O O W 00 M m m U > CO O J0 a C! u U CC a U N > V V U U c M U 1n 0- m o in V-1 Vet 0 1n 1n ONO u N O C N N V O 0 ci .--1 - L T 0 M m ml l0 .-I M C.-I C V V V V M M V CO " -O N_ OJ Z E VIO E VI N 0 CC 03 CO W "O U in U 7 V C 5 O OD CO T _� O C O a C _ N C 0 CC Z z m U s d 4 U ? L o TO .1°+ O 4O CI cc z Lu z a 10 > 1a T a- CO a V) CC a � L. ,� r v E , �, Ln oaNwd' O z_ O w n Z E u ul a f_ Y W ~ W C C O (N C In zo 2 a u cc Z H = a u v a ai on • 1n a J 0 w > 2 U T E N L C K D J Ul a+ N IIIMPIPC rl 0 a U cC - w N .� N C O 0_' M Z = m x z a) 1:a 'i W 0 of a a v a O O w LU t y Ln 0 u z z 2 2 m U _ 0 0 x z • Case#: USR-1750 Name: Bob White,do Viaero Wireless Proposed Project: USR for 330 foot wireless communication tower&related accessory buildings in the Agricultural Zone District Location: North of and adjacent to CR 86 and north and east of the intersection of CR 81 and iit — � Weld County Planning Services CR 86 I/ \I 1555 N 17th Ave Planner: Chris Gathman Greeley CO 80631 Ingle(970)353-6100 ext. 3540 COLORADO 35 • • Case#: USR-1750 Name: Bob White,do Viaero Wireless Proposed Project: USR for 330 foot wireless communication tower& related accessory buildings in the Agricultural Zone District Location: North of and adjacent to CR 86 and / t north and east of the intersection of CR 81 and / �r/�, Weld County Planning Services CR 86 IVY u 1555 N 17th Ave Planner: Chris Gathman 31 Wile(970)353-6 00 ext.eeley CO 3540 COLORADO 35 • Ir _ _ • C 0 y N 0 CO U v CZ_ 0) i+ y C• N a T r Lc •it C .3 2 CUL0 f C V) C co y rl r-I ri rl r-I V ri 'O to r-1 r♦ N r-I m r-I p L tD l0 W LSD V1 tD LO O LL O O O O N O O u -O W CO CO CO CO m 00 CO R N Co. - 0) tn L a` a 1 C a) o 00 N Y o w a 1- 0000 D U U 0 O c� • }N} J -J J J O J a G F n o O n W > 0 m ) U Vl V) VI in Z W ti) Y C7 O W l7 -4 (.7 l7 l7 U' l7 Ln w W C 'j1 K C K K w K 2 O -O tY] m m m l.7 CO C c tn r a) 4- L r- O c C in ~ a O0 ri O cc w N N Z W LO u N N O m rn co m 0 m M o0 00 C7 > ao u ck cu a z cc c cc z a cc 0) to c U U U U m V >_ D rl r-I u-) r-I CL M W 0 V- V1 in in O U V1 (-.4 U 0) O 0 N N a O V1 r'1 r-I ID -0 > m M r-I tD r1 en r1 C E ro '� V '0- V V M m V @ > -O D Z y E D E Vl 0 CC CO CO U H V Z CL) C 1.+ o� 00 ra y a) O C O a C — o C7 > o v C a 0 s d In a (J CC Z Z L -a rro Q V.O. O < w Q Q O v C0 > a' CC wz 22 a) o .° 0 o fliflfi " -C ZVI C oa) riplik VI -ri H E .5 v a) .-• o cc cc cic v) in z 2 m tr cc a) "O Q) V) U V) Q Q V c Q c=« (-) < = 0 CC uJ C v -O tO a) V) D U K 2 c c m U — i it 0 Y C • • • • • AFFIDAVIT OF INTEREST OWNERS SURFACE ESTATE Property Legal Description: S i/V V* oV S Y4 e cec+fa h 3 j owe 1.e ovt-k C z�, � Co 2 Wes Parcel Number 0 5 I+ 5-_3 5 - ® - C9 O - O 03 (12 digit number-found on Tax I.D.information,obtainable at the Weld County Assessor's Office,orwww.co.weld.co.us.) (Include all lots being included in the application area, If additional space is required,attach an additional sheet) THE UNDERSIGNED, being first duly sworn, states that to the best of his or her knowledge the attached list is a true and accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned by the Weld County Assessor of the owners'of property(the surface estate)within five hundred (500)feet of the property being considered. This list was compiled from the records of the Weld County Assessor, or a person qualified to do the task, and shall be current as of a date no more than thirty (30)days prior to the date the application is submitted • to the Department of Planning Services. By: Z-41“,(- ,ttn Title: �lreCtOr o &t+Q Rct,iris/11 on The foregoing instrument was subscribed and sworn to me this day of c./z- e , 20 i0 . WITNESS my hand and official seal. My Commission Expires: 5/10 � ,JEFF h %' . . R, It 7� v O cr ;•1.lOTARY• /�i Notary b • r.er i e4 '• PUBLIC t ‘‘‘OF C O My Commission Expires 08/25/2013 • -13- AFFIDAVIT OF INTERESTED LAND OWNERS Page 1 of 2 • • • AFFIDAVIT_OF INTERESTED LAND OWNERS SURFACE ESTATE Subject Parcel: 054535000003 THE UNDERSIGNED, states that to the best of his or her knowledge the attached list is a true and accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned by the Weld County Assessor of the owners of the property (the surface estate) within 500 feet of the property being considered. This list was compiled utilizing the records of the Weld County Assessor available on the Weld County Internet Mapping site, http://www.co.weld.co.us, and has not been modified from the original. The list compiled from the records of the Weld County Assessor was �— assembled within thirty days of the application's submission date. l �/%�/_ J �" Signature 60 8- Zoio Date Property Owners Within 500 ft. of Parcel# 054535000003 NAME MAILING ADDRESS PARCEL IDENTIFICATION • 43251 CR 392 CASS FARMS CO BRIGGSDALE,CO 054527000011 80611 43251 CR 392 CASS FARMS CO BRIGGSDALE,CO 054534000009 80611 CASS RANDOLPH J & 43251 CR 392 054525000010 Additional Owners: BRIGGSDALE,CO CASS JUDY 80611 CASS RICHARD E & 41455 CR 86 054536300001 Additional Owners: BRIGGSDALE,CO WHITE-GAFFNEY PATRICIA L 80611 46001 CR 83 FREEMAN MARGUERITE REV TRUST 054526000002 BRIGGSDALE,CO 80611 315 SPRING LN KERSANAC MURI LYN AKA CASS 071503000010 MURI L • DESTIN,FL 32541 WHITE BOB E 3315 33 AVE CT 054536400002 http://maps2.merrick.com/website/weld/setsgl.asp 6/7/2010 AFFIDAVIT OF INTERESTED LAND OWNERS Page 2 of 2 • • GREELEY,CO 80634 3315 33RD AVE CT 41) WHITE BOB E 054536000006 GREELEY,CO 80634 41128 CR 86 WHITE JERRIE L BRIGGSDALE,CO 071501000009 80611 41128 CR 86 WHITE JERRIE L BRIGGSDALE,CO 071502000001 80611 • • http://maps2.merrick.com/website/weld/setsgl.asp 6/7/2010 • SEN•E•: C•M•LETE THIS SECTI•N C•MPLE iE THIS SECTI•N •N •ELI VE•Y • Complete items 1,2,and 3.Also complete A. S. ature item 4 if Restricted Delivery is desired. ,/�• O Agent • Print your name and address on the reverse X-�' •� .-� / �`V-'L O-Addressee so that we can return the card to you. B. R: eived by(Printed ame) C. Date of•=livery • Attach this card to the back of the mailpiece, — or on the front if space permits. •e D. Is delivery address different from item 1? O Yes 1. Article Addressed to: If YES,enter delivery address below: O No John S. Gibson Production, LLC P. O. Box 842 Ft. Morgan, CO 80701 a Service Type *edified Mall O Express Mail eglstered ❑Return Receipt for Merchandise O Insured Mail O C.O.D. 4. Restricted Delivery?(Extra Fee) O Yes Article Numt 7009 2250 0000 0110 70L (Transfer from-sake label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1940 • SEN a E•: CIM•LETS THIS SFCTIaN COMFI:. ,t I NIti SF CTI•N IN •ELIVERY • Complete items 1,2,and 3.Also complete A. SI natu Item 4 if Restricted Delivery is desired. O Agent • Print your name and address on the reverse X , ��' ■ Addressee so that we can return the card to you. tvedpy(Printed I: : .aktep •elivery G • Attach this card to the back of the mailpiece, • o• n the front if space permits. ' f r / d^ • D. Is delivery address d _ =r fro hem I) s 1. le Addressed to: If YES,enter delivery ad• ,-= 0 N Flatiron Energy Company, Inc. � 6666 Gunpark Drive, Suite 200 Boulder, CO 80301 a. ice Type Certified Mail O Express Mall Registered O Return Receipt for Merchandise ❑Insured Mall O C.O.D. 4. Restricted Delivery?(Extra Fee) O Yes . Article Numt Maniac from.,,.,vlce 1ettt.i ll nl1y91re5CI 0000 01. 7095 PS Form 3811,February 2004 Domestic Return Receipt 102595.02-M-1540 • SENIE• CAM•LETS THIS SECTION CIM•LEIc rr,issw noN IN •ELIVE•Y • Complete items 1,2,and 3.Also complete A. Sign Item 4 if Restricted Delivery is desired. X 2 _1 '7 0 Agent • Print your name and address on the reverse G �•�"" 0 Addressee so that we can return the card to you. B. Rficeiv:• by(Printed N mq)y rate, p off Bei • Attach this card to the back of the mailpiece, w t I g " v4"W" or on the front if space permits. 1 D. Is delivery address different from item 1? 0 Yes 1. Article Addressed to: If YES,enter delivery address below: 0 No Bob E. White & Keitha E. White 3315 33rd Avenue Court 3. oe Type Greeley, CO 80634 `tined Mall 0 Express Mail Registered 0 Return Receipt for Merchandise ❑Insured Mail 0 C.O.D. 4. Restricted Delivery?(Extra Fee) 0 Yes 2. Arti(Ttans Nur 7009 2250 0000 0110 7125 (Transfer froth-service IabelJ PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 • SENDER: COMPLETE THIS SECTION COMPLETE THIS S[CTr0N ON DELIVERY • Complete items 1,2,and 3.Also complete4/au Rem y R r name an Daddery Is dn the r. Onre■ Print our name and address on the reverseso that we can return the card to you. ,ed tanted Name) C. Date of Delivery • Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1;FMlkie Addressed to: If YES,enter delivery address below: 0 No Grindstone Resources, LLC 5228 Lonetree Drive Loveland, CO 80537 3. ce Type Certlfted Mall 0 Express Mail egistered 0 Return Receipt for Merchandise ❑Insured Mail 0 C.O.D. 4. Restricted Delivery?(Extra Fee) :❑yes 2. Article Nu` 7009 2250 0000 0110 7101 (Transfer host,.servke label) PS Form 3811,February 2004 Domestic Return Receipt io258s-02-M-tsw • • SENeE•: C•M'LETE THIS SECTIaN C•M•LETE THIS SECTION W .SLIVERY • Complete items 1,2,and 3.Also complete A. 'gnature Agent X item 4 if Restricted Delivery is desired. �l • Print your name and address on the reverse /,`�,., ❑Addressee so that we can return the card to you. R. - ed by PH • Na e) C. Datef Delivery • Attach this card to the back of the mailpiece, \ or on the front if space permits. D. Is delivery address different from Item 17 O Yes 1. Article Addressed to: If YES,enter delivery address below: O No Daniel F. Brooks 3237 N. Forest Lakes Wichita, KS 67205 "Ice Type Certified Mall Cl Express Mall egistered O Return Receipt for Merchandise O Insured Mail O C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Nun 7009 2253 0000 0110 7071 (Transfer Ira,.-.nice label_ —..__ __. PS Form 3811,February 2004 Domestic Return Receipt 10•015404.vfs4o • • Hello