52130_SHEARIN FAMILY INVESTMENTS, LLC_20080124

❑ CANANA / ❑ DREDGE & FILL
r. GENERAL PERMIT Previous perrfiit#
❑New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # ( ) Fax # ( )
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
M.
•
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
MAN
i�■■■iil■■■■�■iiii■■■®■■■■■■■■■■■■■■■■■■■■
■■n■■■�■■■®■■■■■■■■■■■■■■■■
■■■■
■■■■■
.■..��...�...■..........■.....■
■■■■
■■■�■■■
■li■■■■■■■I!■®■■■®■■■■■■■■■■■
..
■■■■■N
■■■■■■■■
■■■■■
■■■■■■■■■■m
.....■■..�■■■...®...■...
■■■■■■■■...
■
■M
:.''J:■■
■■■■OMEN :■M■■■■■■■■■�: _
■■■��■■■
■■■■■■■�1!■■■■1�■■■■■■�I■in 0
■■■■■■■■■■■■■■■�i■►�■■■■■■17i■ ■■■H■■■■■
■■■■■■■■■■■■■■■EEO ►1■■■■■I■I-ME■■■►1■■■■■
■■■■■E■■MiO■■■■Oi■■i�UMME'i■�=27121MEMEME■■
e-tt.
Agent or Applicant Printed Name
Si nature Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature
r V"
Issuing Date Expiration Date
l ot,
Local Planning Jurisdiction Rover File Name

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
Iandowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythatthis project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888-4RCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

BARTLETT
ENGINEERING & SURVEYING, PC
1906 Nash Street North Wilson, North Carolina 27893-1726
Tel [phone] Fax [phone]
January 14, 2008
Brad Connell
NC Department of Environment
and Natural Resources
Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
ff�
410rehle ea 2008
%WJr
Re: The Nautical Club/Adjacent Riparian Property Owner Statements
Dear Mr. Cornell:
As per your e-mail dated 01/07/08, the adjacent riparian form was sent to Tradewinds
MHP on 01/07/08. After you receive this, please call to establish a meeting time and to
notify us of amount of applicable permit fee(s). A Thursday meeting would be better for
either Robert or myself if it fits in your schedule.
Attached is the green card indicating that adjacent owner Tradewinds MHP has
received certified mail as previously sent to you on 12/27/07.
I believe that this provides the additional or revised information required. However, if
additional information is needed, please contact either Robert or myself.
Sincerely,
i
illiam P. Bartlett, PE, PLS
Bartlett Engineering & Surveying, P.E.
Enclosures

BARTLETT
ENGINEERING i SURVEYING, PC
�(1 le c'n
v7/en-s
1906 Nash Street North Wilson, North Carolina 27893-17
Tel [phone] Fax [phone]SIV ED
1�
DEC 2 8 2007
December 27, 2007
Brad Connell
NC Department of Environment
and Natural Resources
Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
Moraneacl City DCm
Re: The Nautical Club/Adjacent Riparian Property Owner Statements
Dear Mr. Connell:
Attached are subject forms, letter granting Bartlett the right to act as authorized agent,
and green cards indicating that adjacent owners have received certified mail.
As per your e-mail dated 12/10/07 and follow up phone call, it is our understanding
that permission to replace existing boat ramp and wooden bulkhead plus the initial 120
linear feet of pier can be granted at a meeting with you on site. After you receive this,
please call to establish a meeting time and to notify us of amount of applicable permit
fee(s). A Thursday meeting would be better for either Robert or myself if it fits in your
schedule.
I believe that this provides the additional or revised information required. However, if
additional information is needed, please contact either Robert or myself.
Sinc rellyy,
William P. Bartett, PE, PLS
Bartlett Engineering & Surveying, P.E.
Enclosures

GO
ADJACENT RIPARIAN PROPERTY OWNER ST NT
(FOR A PIERIMOORING PILINGSIBOATLIFTIBOAT USE)EC 2 8 Z007
I hereby certify that I own property adjacent to -fit49sAJ "4-f • t 9 'tv DCM
' " (Name of Propecaner � �#
T-lr- IV,4 vrl c A L C C u /3 sv LA A4 0 Sr of
property located at L -�5— 6-22 J �2 L ZZZ j: ,;�
(Lot, Block, Road, etc.)
on o C, v G-' Jfv �,t11� , in .1-,a V, c=
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development) _ _ / p s
N �
v)
3oCtivt 14 C
� o oNP
IFrLa"Pr,r2
N
0 0
1�, —IF f zi?4N F,T- L,
.E' xi 5 -. \,-1no $Vt-k 9 G 0 0
-pgo 1 35Eo 13E T?EPCAC!_�
!,7"r4 tP r uLKHCAP/.'OA4 a�E �S T B��KrIGn�
1�PP 2 1/1/1TC12 W P R D
F3oqr =�„re '1`lAU i 1,-PL CLOe
io 9C-#EPc.r1CFv 1 S$U SFrCTF?, PAT�k 1Z0
vJ I t t-t 1 4- ' x 4 o c z Ale .
r?j o /a 'r- R tck r" %j
CScC��/rnoNT' 7��or�z�/Zi rF�
------------------------------------------------------------------------------------------------------------------
i�C% t✓. -�( S:5 o Signature
TZ�
e-A IPA7W, �SG Z.� S � � O C eAN IOW_o AI f Pd o tGE.eTiEs
% VA �—& 611,4 v Omit v
• / �7a SALsE2 r��r�, 2 Print or Type Name 4 4ig_,,v7-
2 "9S/v
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Z-4 e-
(Name of Prop rty Owner)
T/�f' 1,//�d 011,1 L- CG ✓ $ ::5� o S �ru
property located at
M
(Lot, Block, Road, etc.)
rcXi
t,•F
on , in r,�/- , N.
(Waterbody) (Town and/or County) ?Q7
He has described to me, as shown below, the development he is proposing atti' d, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / bo1�;CM
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�T��rc 1,JIr4PS
\glob Q bvLK NCAp
N CA A- � p�o.5 o gE VEPC. Ac�Sl
F�VCuLrrc�Ar/!°o�c%,^1� N
v S I ApP, 2' '1<1/aTE4 14P R v 5 r
"J3oc}ue- 0 A7, f4Au , lCAz CLve
io t�iG 6PL✓CfFP SU 5#tCTT, F-P,-r l2.li
14-•x40czAle
goat /7�;mP
0 0
------------------------------------------------------------------------------------------------------------------
Signature
Z-5'5� �,�� �v Print or Type Name
:2 7,9 S -7 Telephone Number
Date:

t 6r
LVautical
T
SHEARI N FAMILY INVESTMENTS, LLC.
J. MARVIN SHEARIN, II
252-985-2252
252-451-5266 fax
[e-mail]
June 22, 2007 �
To Whom It May Concern:i�
C
I am the owner of 13.5-L acres of land located at 1550 Salter Path Road, Atlantic Beach, North
Carolina 28512 and now constructing a condo project known as the Nautical Club Soundside.
This property is recorded in Deed Books 1156, Page 127, 1194, Page 351, and 1194, Page 353,
Carteret County Registry. I grant to Bartlett Engineering & Surveying, P.C., 1906 Nash Street
North, Wilson, North Carolina 27893, the right to act a my Authorized Agent in applying for
permits to construct a pier, boat slips and lids and a covered platform to serve this property.
hearin . iiily Investments,

To: Adjacent Property Owner
This is to advise that the adjacent property owner Shearin Family Investment,
LLC/The Nautical Club — Soundside formerly (Arrowhead Campground) is making an
application to construct a pier and replace boat ramp and wooden bulkhead as indicated
on the attached adjacent riparian property owner statement form. Also you have 10 days
from the receipt of this notice to submit written comments to:
N.C. Department of Environment and Natural Resources
Attn: Brad Connell
Division of Coastal Management
400 Commerce Avenue
Morehead City, N.C. 28557
No response will be interpreted as no objection to this proposed construction.
%,,.h.ad CAY DCM

PO Box 577 V�V'AS'�HJ,N GTO N Office [phone]
660 Carolina Ave. INSURANCE Fax [phone]
Washington, NC 27889 8L TAX [e-mail]
27 December 2007
Bartlett Engineering &Surveying, PC
CEI
ON ze
1906 Nash Street North 34 N 2 2008
Wilson, NC 27893-1726
MOrehead QtY pCM
Bartlett Company and Shearin Family Investments LLC:
I appreciate the letter that you sent me regarding the attached
proposal. I must, however, inform you that the land my mobile
home is located on is Tradewinds MHP property. Please
this letter to the association by mail to: Tradewinds MHP, PO Box
339, Salter Path, NC 28575.
I would also like to take this opportunity to clarify ton the attached
rea of
riparian access to you for future reference. As seen
map of Tradewinds MHP, the riparian access f r the MHP s
highlighted in purple. The drawing issued howl it as
to do with your
being the yellow line. I know this has not ri
current proposal but I do want to make sure that you're�aware of
the line.
Sincerely,
e'o Lee
Lot 32 Tradewinds MHP
CC: Brad Connell, CAMA, 400 Commerce Ave., Morehead City,
NC 28557

DOMOR souup
t11
s
4 0.
�y
�N
008
ty DCM

To: Adjacent Property Owner
This is to advise that the adjacent property owner Shearin Family ; t
LLCIThe Nautical Club — Soundside formerly (Arrowhead Campground) ism ng CI QtY DCM
application to construct a pier and replace boat ramp and wooden bulkhead as indicated
on the attached adjacent riparian properly owner statement for;. Also you have 10 days
from the receipt of this notice to submit written comments to:
N.C. Department of Environment and Natural Resources
Attn: Brad Connell
Division of Coastal Management
400 Commerce Avenue
Morehead City, N.C. 28557
No response will be interpreted as no objection to this proposed construction.

ADJACENT RIPARIAN PROPERTY OWNER STATE
(FOR A PIER/MOORIIVG PILINGS✓BOATLIFTBOATHOUSED
) JA N 2 2008
I hereby certify that I own property adjacent�.��
(Name of Pro rty Owner') '' y DCA
72,4C1014,' n44t- CGt/0 :::� s'A6-
property located at
(Lot, Block, Road, etc.)
on 11 , in , N.C.
(Waterbody) (Town and/or County)
He has desc-,ibed to me, as sbo� n+ below, the deve!o merA he is Mposing at that location, and, T
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�1 PA R 1pr4 �J��0c l.�i/rpD�
x� �T 1.Jno Q bvt-k gepo
�flo�osED o 13E 7?EPCAcG9
11t 7-(4 -pV C 5uc.rrcCAD./r'o,�/eaEfC- CAP v,-et46AO
vi G I 1�ApP. 2` 'I�1/9TER LJARD os^ E(rST' 8
3 o Cti vt
S o u ND 1= KisT 9 O q! 2ranV
10 AcPg15F'C"AcFD 121?
vJI r14 t E�-' x 40
gaa'- I?Arr+P
12�' xlp' N
11 o
RfPa rzi�� �Ro nceT� L�,-rc
6 2/.•1E's L.AAJO a. c,
279S7
aCC/qr/r/1oq—t PRoPL-'jLi1FS
Signature
Print or Type Name
Telephone Number
Date:

1/12/08
MR. BARTLETT;
PLEASE SEND ALL CORRESPONDENCE TO:
BETSY LANE ( PRESIDENT OF TRADEWINDS ASSOC.)
PO. BOX 404
SALTERPATH, NORTH CAROLINA 28575
THIS WILL ASSURE YOU THAT THINGS ARE HANDLED AS QUICK
AS POSSIBLE.
THANK YOU
BETS�Y�L�

To: Adjacent Property Owner
This is to advise that the adjacent property owner Shearin Family Investment,
LLC/The Nautical Club — Soundside formerly (Arrowhead Campground) is making an
application to construct a pier and replace boat ramp and wooden bulkhead as indicated
on the attached adjacent riparian property owner statement form. Also you have 10 days
from the receipt of this notice to submit written comments to:
N.C. Department of Environment and Natural Resources
Attn: Brad Connell
Division of Coastal Management
400 Commerce Avenue
Morehead City, N.C. 28557
No response will be interpreted as no objection to this proposed construction.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLIFTBOATHOUSE)
1 hereby certify that I own property adjacent to S.UEA,2in/ vEtfr~sLGt
(Name of Prop rty Owner)
7i,e-er ly�4&-, 17,44L- cz ✓d
property located at Z-::L T,o/- �ilV /�D
(Lot, Block, Road, etc.)
on1L'W4725z,,4,:r- , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at thai location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
1 do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
7?1 P1.; R rpN F1Z0FzLar4 �,
1�3aC,UE
� o AND
NQ L.g/-)t l,J/IVP
N ��flo?USED %c 136 RFPr- Acr9
0 I W,T►-4'PVC CAI'
G APP. 2' -I,c1,977E1� L-IARD or E7t,577 Bvt-KrIGAO
Q �o rya �c-o F ►sr.�
�IPa a PRO PFJzTy 2
t: lers% B o'QT 'aAU TIC C AL CLUB
10 AC- )q6F L1 CFv ( 5 5p S MLTE;� pATA 12.0
vJJ zK 1 4- x 40C -0 .0'< .
$an'r RArNP "'w
0CC/4,-//=20fir7' PRoPL-iZ 1F-,
---------------------------------------------------------------
Signature
Print or Type Name
Peg. A0 x 33 g
�A Lrcz t O.4r-,% VC
.7- 957S
Telephone Number
Date: ��� —

PU0 HERE
HE DOCUMENT CHANGES COLOR GRADUALLY AND EVENLY FROM DARK TO LIGHT WITH DARKER AREAS BOTH TOP AND SOTTO
THIS MULTI -TONE AREA OFT Q Q
Y i
StFaDEs
Jj
N07 VALID OVER $1,
�s l
ISSUING BRANCH 93-541/920
DATE r.
30
PAY TO THE / \ '� 1+� �1 I " LLARS PURCHASER, BY SIGNING YOU AGREE 70 THE SERVICE
ORDER OF !� 11- JP ! k D� CHARGE AND OTHER TERMS ON THE BE
SIDE
�— �• � � � � Illy
BB T
DRAWERTRVE 9476 RS EX LRIS, MN O480 NY, INC.
( DRAWEE: FIRST INTERSTATE BANK, HELENA. MT l / �7
II■6370L693Its 1;0920054L11:01707L045109211' EATURES Wll.L INDICATE A COPY-
e eelt RO-PRIM SIGNNI URE LINE AND BORDER. ABSENCE OF THESE F■
THIS MULTI -TONE AREA OF THE DOCUMENT CHANGES COLOR GRADUALLY AND EVENLY FROM DARK TO LIGHT WITH DARKER AREAS BOTH TOP AND BOTTOM
PJ6 HfgF
NOT VALID OVER $1,000.0p 63701694
ISSUING BRANCH "I
DATE _if=ik"t' ._.
93-541/920
PAY TO THE
ORDER OF
BB&T
DRAWER: TRAVELERS EXPRESS COMPANY, INC.
P.O. BOX 9476, MINNEAPOLIS, MN 55480
DRAWEE: FIRST INTERSTATE BANK, HELENA, MT
LLARS PURCHASER, BY SIGNING YOU AGREE TO THE SERVICE
CHARG D-OTHER TERMS ON THE REVERSE SIDE.
AIP
LA DDRE
CITY & STATE
II■6370169411' i:0920054L0:01,707L045L092u■
■ THIS DOCUMENT HAS AN ARTIFICIAL WATERMARK PRINTED ON THE BACK. THE FRONT OF THE DOCUMENT HAS A MICRO -PRINT SIGNATURE LINE AND BORDER ABSENCE OF THESE FEATURES WILL INDICATE A COPY. ■

S p�
l UNITED7kS^'Vjt
� _,
• Sender: Please print your name, address, and ZIP+4 in this box •
BARTLE T ENGINEERING
It SURVEYING, PC
1906 NASH ST. NORTH
WILSON, NC 27893
TEL. [phone] FAX [phone]

■. Complete items 1, 2, and 3. Also complete
( item'4 if Restricted Delivery is desired.
1 ■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
i
1, Article Addressed to:
Tradewinds MHP
PO Box 339
Salter Path, NC 28575
COMPLETE THIS SECTION ON DELIVERY
B. Received by (Punted Name) kc. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
if YES, enter delivery address below: ❑ No
10 JAN 1 2008
DNA
3. S Ice Type
Certified Mail ❑ Express Mail
Registered ❑ Return Receipt for Merchandise }
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7006 3450 0003 5039 9828
(Transfer from service label)
PS Form 3811, February 2004 Domestic Retum Receipt 102e9e-02-M-1540

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPs
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
BARTLETT ENGINEERING
Ft SURVEYING, PC
1906 NASH ST. NORTH
WILSON, NC 27893
TEL. [phone] FAX [phone]
1

�Y
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Oceam mt E aterprol"
PO Box S30
Sailer Path, NC 211675
Attention: Dave Gagemom Marty
A Signature
i
Agent
13. Received by (PHnt&68Narh&) \C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
�ertified Mail ❑ Express Mall
Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7006 3450 0003 5039 9804
(Transfer from service labeo
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATES POSTAL. SERVICE...
Fist Class -Mail
­'.: _P105tag6 & �66S Paid
f4C. 2 7
•
Sender: Please print your name, address, and ZIP+4 in this box •
BARTLETT ENGINEERING
it SURVEYING, PC
1906 NASH ST. NORTH
WILSON, NC 27893
TEL. [phone] FAX [phone]
illkh. Ilflhlililk 1. Ifi,,;. iii. 'J"kidi"ji .111HIIiI1., 11,

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
Leo D. Lee
259 Fwwm%lton Road
Gfimnbnd, NC 27837
A. Signature
Agent
❑ Addressee
6._j3ec by (Pont d Name) C. Date of Delivery h
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
%Certified Mail ❑ Express Mail
Ll Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7004 1,1,60 0006 701,9 1,551,
I (Transfer from service label
PS Form 3811, February 2004 Domestic Retum Receipt 102595-02-M-t540