36844D - Costa

IN
'IA/ DREDGE & FILL
-)3(3)i
3ENERAL PERMIT Previous permit#
New --Modification Complete Reissue -Partial Reissue Date previous permit issued
-izOd by the State of North Carolina,Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7 .4.1 C)O
❑Rules attached.
t Name Project Location: County /t J / f d <, k vY
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• GENERAL PERMIT COMPUTE R FORM
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ZONAL NAMES:
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)ESIG: -W t r DEVELOP AREA: - C' PROJ DESC: P - l Z
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ACTION DIVIRATION
sE&FILL REQUIRED. �, ' (f 1 Z �''fl -- .- Q
(/
.MAJOR DEVrEI, ,REQUIRED: Vi-1' l v°11- -5-12'f"0/

-Width pf dock 6 feet
Length of dock and walkway 372 feet
OLoating pier dimensions 8' wide 18' long
Dock setbacks
15 feet from the southern line of the Sept. 24,
2003 "Hobbs" survey for Brooks.
15 feet from the southern line of the August 7,
2003 "Stocks" survey for Costa
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AMA / 'C DREDGE & FILL J N9 342
NERAL PERMIT Previous permit#
>,N C Modification C Complete Reissue EPartial Reissue Date previous permit issued
d by the State of North Carolina,Department of Environment and Natural Resources ,ZOQ
stal Resources Commission in an area of environmental concern pursuant to ISA NCAC
lame {'o /c ') CDSZk Project Location: County traes011>iff"--
1
1 10 t'NCL) ,\ \il. Street Address/State Road/Lot#(s)
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permit may be required by: AJ2 1(1010,26f 6 • . ❑See note on back regarding River Basin rules
ecial Conditions ("1 /1S'f-1't.c4il-t Ai aelviipi,4, wi 7TT • rZOo G1 S l/e 1( a c G7/ ,P144 41

e1A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
ilichael F. Easley, Governor Charles S. Jones,Acting Director William G. Ross Jr., SI
March 9, 2004
:ertified Mail - 7003 1010 0000 0032 1532
teturn Receipt Requested
4r. Philip Brooks
407 Rondo Place
Vilmington, NC 28412
'ear Mr. Brooks:
This letter is in response to your February 24, 2004, correspondence regarding your concerns about the
roposal by Mr. Jonathan Costa to construct a pier and floating dock on his lot, adjacent to your property, at 31
Jindy Hills Drive, located off of Shannon Drive, in Wilmington, New Hanover County.
According to you, there were some discrepancies concerning proper notification by your neighbor, Mr.
osta, for the proposed construction of a pier and dock located at 315 Windy Hills Drive, in New Hanover Cot,
respite the fact that the applicant, Mr John Costa, provided the Division of Coastal Management (DCM) with a
ird" or certified mail receipt signed by Stephanie Brooks, illustrating that you received proper notification of h
construct a dock on hisproperty, the DCM is directlynotifying
you of Mr. Costa's intentions to build a pier
ck on the subject property. Enclosed, you will find a copy of the work plat drawing, provided by Mr. Costa,
.dicating the proposed location of the pier and floating dock.
If you have any questions regarding the contents of this letter, you may contact me at [phone].
Sincerely,
�/ ason Dail
Field Representative
James H. Gregson, District Manager, DCM
Charles Jones,DCM
Merrie Jo Alcoke,AG's Office
John Costa, 1118 Audobon Blvd,Wilmington,NC 29405
:AMAUason\Objecti on\Brooks.obj.Mar.04

AT7A,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Gael F. Easley, Governor Charles S. Jones, Acting Director William G. Ross Jr., Secr
Notice of Suspension of CAMA General Permit No.36844-D
tilled Mail - 7003 1010 0000 0032 1501
irn Receipt Requested
February 25, 2004
Jonathan Costa
Audubon Blvd.
iington, NC 28403
Mr. Costa:
This letter is in reference to CAMA General Permit No. 36844-D, issued to you on February 24, 2004, foi
:ruction of a private pier (6' x 372') and floating dock (6' x 18'), at your property, located at 315 Windy Hills
er New Hanover County Tax Office), in Wilmington, New Hanover County.
Based upon information brought to the attention of the Division of Coastal Management, it appears that the
ning property owners, Philip and Stephanie Brooks, did not receive a copy of the workplat for the proposed pi
lock configuration for the property owned by you and located at 315 Windy Hills Drive, prior to you obtaining
it.
Under these circumstances, the Division of Coastal Management is suspending CAMA General.Permit No.
4-D. The permit will remain suspended until the Division determines that the issues regarding the proper
cation have been resolved, as per 15A NCAC 7H .1202(b)(2). At that time, the Division will re-evaluate the
it decision, and determine whether or not the permit could have been authorized under the provisions of the
ral Permit.
The Division requests that you notify Philip and Stephanie Brooks, via certified mail, and provide them wit
plat drawing that illustrates the approximate location of the proposed pier and dock, at the property located at
y Hills Drive. You must also notify them that any objections or comments should be provided in writing to th
ion of Coastal Management. To facilitate this, I have enclosed the Division of Coastal Management Adjacent
•ian Property Owner Notification/ Waiver Form.
S' cerely,

• ArA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
hael F. Easley, Governor Donna D. Moffitt, Director William G. Ross Jr., Sec
lip Brooks
7 Rondo Place
mington, NC 28412
r Phillip:
As discussed during our telephone conversation on November 3, 2003, I am writing you to confirm
do not need to file for a Third Party Appeal at this time, concerning the recent issuance of CAMA Gen
nit No. 34246-D, to Mr. Jonathan Costa, or your adjacent property owner to the south. CAMA Permit l
46-D was issued to Mr. Costa for the construction of a pier and floating dock at 315 Windy Hills, in
mington, New Hanover County. According to recent information provided by you, there was an establi;
existing riparian corridor in place prior to the time that Mr. Costa received CAMA General Permit No.
46-D.
Division has sent a letter to Mr. Costa (Notice of Intent to Suspend CAMA General Permit No. 34246.
rming him that the survey/drawing he provided is inaccurate and indicates discrepancies between the
inal riparian survey, provided by you and surveyed by Hobbs Surveying Co. Inc., on September 7, 199
stocks Land Surveying P.C., survey that was submitted with Mr. Costa's application.
it Mr. Costa can submit a revised drawing, CAMA Permit No. 34246-D will be suspended, and you wi]
1 to file for a Third Party Appeal. Once the revised drawing has been received and you have been renoti
to proposed work, you will have the opportunity to comment and/or file for a Third Party Appeal.
)u need any further assistance regarding this matter, please feel free to contact me at [phone], ea
Sjn�,tely,
Jason Dail
Field Representative

12-2004(TUE) 17:22 C. WES HODGES, II ATTY. (FAX)910 7721723 P. 001,
FACSIMILE
C. WES HODGES, II, P.L.L.C.
Attorney at Law
3138 Wrightsville Avenue
Wilmington,North Carolina 28403
Telephone: [phone]
Facsimile: [phone]
TO:
Name: Jim Grcgson
Re: Jonathan B. Costa
CAMA General Permit No. 36844-D
315 Windy Hills Drive, Wilmington,N.C.
Fax Number: 350-2004
Transmission Date: March 2, 2004
Number of Pages: 5 (including cover sheet)
FROM:
Name: Wes Hodges tAgR 1-‘Y4A
Comments: p\\ISMANoGG,E.--
P� t�
GO AS�
The information contained in this facsimile message is attorney-privileged and confidential information intended

2-2004(TUE) .17:22 C. WES HODGES, II ATTY. (FAX)910 7721723 P. 002i
C. Wes Hodges, II, P.L.L.C.
Attorney at Law
3138 Wrightsville Avenue Telephone: [phone]
Wilmington, N.C. 28403 Fax:[phone]
Email:[e-mail]
March 2, 2004
VIA FACSIMILE AND REGULAR MATT,
Jim Gregson
District Manager
NCDENR
Division of Coastal Management
127 Cardinal Drive Extension
Wilmington,N.C. 28405-3845
Re: Jonathan B. Costa
CAMA General Permit No.36844-D
315 Windy Hill Drive,Wilmington,N.C.
Dear Mr. Gregson:
t represent Jonathan Costa in connection with this matter. Enclosed please find a letter from me
to Philip and Stephanie Brooks, via certified mail (return receipt requested) enclosing a Division
of Coastal Management Adjacent Riparian Property Owner Noti fication/Waiver Form pertaining
to Mr. Costa's application for a CAMA permit, along with a drawing showing the approximate
location of the proposed pier and dock. There should now be no dispute as to whether Mr. and
Mrs. Brooks have received the appropriate notices.
Moreover, based on a conversation between you and Mr. Costa, it is our understanding that the
20-day time limit for Mr. Brooks to object to the issuance of the permit,which runs from the date
of issuance of the permit (in this case, February 24, 2004), is not tolled as a result of the claim by
Mr. and Mrs. Brooks that they did not receive the proper notification prior to issuance of the
permit. If there is a misunderstanding regarding this fact,please contact me immediately.
Thank you for your anticipated cooperation in this matter.
Aincirely oufs,

12-2004(TUE) 17:22 C. NIES HODGES, II ATTY. (FAX)910 7721723 P. 003,
C. Wes Hodges, II, P.L.L.C.
Attorney at Law
3138 Wrightsville Avenue Telephone: [phone]
Wilmington, N.C. 28403 Fax: [phone]:
Email: [e-mail]
March 2, 2004
VIA CERTIFIED MAIL (RETURN RECEIPT REQUESTED)
Philip and Stephanie Brooks
4407 Rondo Place
Wilmington,N.C. 28412
Re: Jonathan B. Costa
Dear Mr. and Mrs. Brooks:
As you know, I represent Mr. Costa. Enclosed please find a Division of Coastal Management
Adjacent Riparian Property Owner Notification/Waiver Form regarding Mr. Costa's application
for a CAMA permit For the construction of a private pier and floating dock, along with a drawing
that illustrates the approximate location of the proposed pier and dock, for his property located at
315 Windy Hill Drive, Wilmington,North Carolina.
If you have any questions regarding this matter,please do not hesitate to contact me.
/ ereptYurs.
`n /\JO
i
a I
C. Wes Ho•_ II
Enclosures ,,N Inc 1° 7 0 11 \\

12-2004(TUE) 17:23 C. WES HODGES, II ATTY. (FAX)910 7721723 P. 004,
• • DIVISION OF COASTAL MANAGEMENT
ADTACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: 7 C
.� 4 h`
Address of Property: 3 ( 'S"-- tA), )L-r L P,
(Lot or Street#, Street or Roa
(City and County)
I hereby certify that I own property adjacent to the above-referenced-property. The in.divic
applying for this permit has described to me as shown on the attached drawing the development 1
are proposing. A description or drawing,with dimensions, should be provided with this letter
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3
within 10 days of receipt of this notice. No response is considered the same as no objecti(
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mus
set bck a minimum distance of 15' from my area of riparian access-unless waived by me.
you wish to waive the setback,you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Sign Name Date
A -

12-2004(TUE) 17:23 C. INES HODGES, II ATTY. (FAX)910 7721723 P. 0051
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C. Wes Hodges, II, P.L.L.C.
Attorney at Law
3138 Wrightsville Avenue Telephone: [phone]
Wilmington, N.C. 28403 Fax: [phone]
Email: [e-mail]
March 2,2004
VIA FACSIMILE AND REGULAR MAIL
Jim Gregson9
District Manager
NCDENR
Division of Coastal Management \\' \\ 9MAR 3 Sall
127 Cardinal Drive Extension
Wilmington,N.C. 28405-3845 pl�llS^PVti OF—
r
Re: Jonathan B. Costa
CAMA General Permit No. 36844-D
315 Windy Hill Drive,Wilmington,N.C.
Dear Mr. Gregson:
I represent Jonathan Costa in connection with this matter. Enclosed please find a letter from me
to Philip and Stephanie Brooks, via certified mail (return receipt requested) enclosing a Division
of Coastal Management Adjacent Riparian Property Owner Notification/Waiver Form pertaining
to Mr. Costa's application for a CAMA permit, along with a drawing showing the approximate
location of the proposed pier and dock. There should now be no dispute as to whether Mr. and
Mrs. Brooks have received the appropriate notices.
Moreover, based on a conversation between you and Mr. Costa, it is our understanding that the
20-day time limit for Mr. Brooks to object to the issuance of the permit,which runs from the date
of issuance of the permit(in this case, February 24, 2004), is not tolled as a result of the claim by
Mr. and Mrs. Brooks that they did not receive the proper notification prior to issuance of the
permit. If there is a misunderstanding regarding this fact,please contact me immediately.
Thank you for your anticipated cooperation in this matter.
,1inclrely youfs,

T., C. Wes Hodges, II, P.L.L.C.
Attorney at Law
3138 Wrightsville Avenue Telephone: [phone]
Wilmington, N.C. 28403 Fax: [phone]:
Email: [e-mail]
March 2, 2004
VIA CERTIFIED MAIL (RETURN RECEIPT REQUESTED)
Philip and Stephanie Brooks
4407 Rondo Place
Wilmington, N.C. 28412
Re: Jonathan B. Costa
Dear Mr. and Mrs. Brooks:
As you know, I represent Mr. Costa. Enclosed please find a Division of Coastal Management
Adjacent Riparian Property Owner Notification/Waiver Form regarding Mr. Costa's application
for a CAMA permit for the construction of a private pier and floating dock, along with a drawing
that illustrates the approximate location of the proposed pier and dock, for his property located at
315 Windy Hill Drive, Wilmington, North Carolina.
If you have any questions regarding this matter,please do not hesitate to contact me.
/ irerepL,Y1urs,
a A
C. Wes Ho,:- II
Enclosures ECaVE \

•
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying,For Permit: C �5 (c;
Address of Property: 3 ( j 1 .---1 ,-((
(Lot or Street#, Street or Road)
(City and Comfy)
I hereby certify that I own property adjacent to the above-referenced-property. The indiv:
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing, with dimensions, should be provided with this left(
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co:
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-:
within 10 days of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu:
set bck a minimum distance of 15' from my area of riparian access-unless waived by me
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Sign Name Date T\ %OF-11111T\

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C. Wes Hodges, II, P.L.L.C.
Attorney at Law
3138 Wrightsville Avenue Telephone: [phone]
Wilmington, N.C. 28403 Fax: [phone],
Email: [e-mail]
September 20, 2004
VIA CERTIFIED MAIL (return receipt requested) ;i
D i
David Pitts
� al� . ..
President SEP 2 1 :'
Charleston Landing at Windy Hills Homeowners Association
P.O. Box 15055 DIVISION OF
Wilmington,N.C. 28408 COASTAL MANAGEMEN
Re: Jonathan B. Costa
CAMA General Permit No. 36844-D
315 Windy Hills Drive,Wilmington,N.C.
Dear Mr. Pitts:
As you know, I represent Mr. Costa in connection with the above-referenced CAMA permit and
the contested case hearing filed by Philip and Stephanie Brooks. At the hearing on September
15, 2004, you informed me that your Association owned the adjacent property and was therefore
entitled to notice of the CAMA permit application. While my client and I continue to believe
that the proper adjacent property owners were notified of this project, I am providing you with
this notice out of an abundance of caution and as a courtesy to you. If your Association does
actually own property adjacent to Mr. Costa's property, this letter and the attachments shall serve
as the notice required by CAMA regulations.
Enclosed please find a Division of Coastal Management Adjacent Riparian Property Owner
Notification/Waiver Form regarding Mr. Costa's application for a CAMA permit to construct a
private pier and floating dock, along with drawings that illustrate the approximate location and
dimensions of the proposed pier and dock, for his property located at 315 Windy Hills Drive,
Wilmington, North Carolina.
.,,a •.-„coati at thA haarinn Tact WPrinPcrlav my client and T xxinnici he alarl to

David Pitts
September 20,2004
Page 2
Thank you for your consideration. If you have any questions or wish to discuss any aspect of
this matter, please do not hesitate to give me a call.
11incerely yours,
' . Wes Ho,ge•, II
Enclosures
ECEz
B. Costa '
cc: Jonathan � f
Jim Gregson(NCDENR) (w/ encl.) �ao�
COAST SEPAL IMZANAOF
G E+V1 E- ��

c �
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
u . � — C Cis' Z,
Address of Property: 3 ( Lk-), -, j
(Lot or Street#, Street or Road
r tit I f / /
(City and Coun{y) /
I hereby certify that I own property adjacent to the above-referenced--property. The indivi
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing,with dimensions, should be provided with this letter
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3
within 10 days of receipt of this notice. No response is considered the same as no objectic
you have been notified by Certified Mail. V -
WAIVER SECTION
•
•
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mus
set bck a minimum distance of 15' from my area of riparian access -unless waived by me.
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback required t E E
I do not wish to waive the 15' setback req i'n eIIiSEP 2 1 20011 1,„))
1 '
nivISION OF
COASTAL MANAbE(-1J
Sign Name • Date
u i}

-Width pf dock _ 6 feet
Length of dock and walkway 372 feet
boating pier dimensions 8' wide 18' long
Dock setbacks
15 feet from the southern line of the Sept. 24,
2003 "Hobbs" survey for Brooks.
15 feet from the southern line of the August 7,
2003 "Stocks" survey for Costa
.
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C. Wes Hodges, II, P.L.L.C.
Attorney at Law
3138 Wrightsville Avenue Telephone: [phone].
Wilmington, N.C. 28403 Fax: [phone]:
Email: [e-mail]
September 24, 2004
-11 C �d V 7:4di
Jim Gregson SEP 2 7 2004
District Manager DIVISION OF
NCDENR COASTAL MANAGEMENT
Division of Coastal Management
127 Cardinal Drive Extension
Wilmington,N.C. 28405-3845
Re: Jonathan B. Costa
CAMA General Permit No. 36844-D
315 Windy Hill Drive,Wilmington,N.C.
Dear Mr. Gregson:
Enclosed please find a copy of the certified mail receipt signed by Linwood Rogers on behalf of
David Pitts, as President of Charleston Landing at Windy Hills Homeowners Association, for the
Division of Coastal Management Adjacent Riparian Property Owner Notification/Waiver Form
in connection with the above-referenced CAMA permit. As you know, Mr. Pitts has contended
that his Association owns property adjacent to Mr. Costa. I previously provided you with a copy
of my letter to Mr. Pitts enclosing the notice form. This notice was provided as a courtesy to Mr.
Pitts and out of an abundance of caution, as my client and I still believe that all adjacent property
owners have already been provided the required notice.
If you have any questions regarding this matter,please give me a call.
incerely o s,
•
C. Wes Hodg , I

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signe e
item 4 if Restricted Delivery is desired. 0 Agent
• Print your name and address on the reverse • ❑Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
• Attach this card to the back of the mailpiece,or on the front if space permits. L . . .�—�
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1. Article Addressed to: If YES,enter delivery address below: ❑ No
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2. Article Number
(transfer from service label) 7004 1160 0003 9525 1257
PS Form 3811,February 2004 Domestic Return Receipt 1o2595-02-M-154o

C. Wes Hodges, II, P.L.L.C.
= Attorney at Law
3138 Wrightsville Avenue Telephone: [phone].
Wilmington, N.C. 28403 Fax: [phone]:
Email: [e-mail]
March 12, 2004
Jim Gregson
District Manager
NCDENR
Division of Coastal Management
127 Cardinal Drive Extension
Wilmington, N.C. 28405-3845
Re: Jonathan B. Costa
CAMA General Permit No. 36844-D
315 Windy Hill Drive, Wilmington, N.C.
Dear Mr. Gregson:
Enclosed please find a copy of the certified mail receipt signed by Philip Brooks on March 5`h,
2004, for the Division of Coastal Management Adjacent Riparian Property Owner Notification/
Waiver Form in connection with the above-referenced CAMA permit. If you have any questions
regarding this matter, please give me a call.
Sincerely ours,
At /9;'
C. Wes ,'odg: , II SIN
Enclosur 3° .3
cc: Jonathan B. Costa MAR 15 �04
D��\S1ON�EMEN1
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• Complete items 1,2, and 3.Also complete A•
item 4 if Restricted Delivery is desired. ❑ Agent
• Print your name and address on the reverse Jl-5 ❑Addressee
so that we can return the card to you. B ��ceiy. • (Printed Name) C. Date De iv. ry
• Attach this card to the back of the mailpiece, r` /
or on the front if space permits. r 3
1. Article Addressed to: D. Is delivery address different from item 1? ClYes
if YES,enter delivery address below: 0 No
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Arr.A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
hael F. Easley, Governor Chafes S. Jones, Director Wiliam G. Ross Jr., Secreta
titled Mail - 7004 2890 0002 3425 2378
urn Receipt Requested
March 21, 2005
Jonathan Costa
3 Audubon Blvd.
nington, NC 28403
r Mr. Costa:
letter is in reference to CAMA General Permit No. 36844-D, issued to you on February 24, 2004, for the
;truction of a private pier (6' x 372') and floating dock (6' x 18'), at your property, located at 315 Windy Hil
Jilmington, New Hanover County. This letter is to inform you that CAMA General Permit No. 36844-D is nc
er suspended pursuant to N.C.G.S. 113A-121.1(c). The petition for contested case hearing challenging your
nit has been dismissed with prejudice. Accordingly, you may proceed under the permit once you have obtain
!ssary approvals. The time that your permit was suspended due to appeal is not counted against the 3-month
ration date pursuant to 15A NCAC 7J .0403(f). However, you still cannot exceed the total 3 month developr
Dd. As such, all work must be completed by June 20, 2005, or you must apply for a renewal of the General
nit. Please contact me at [phone] if you have questions concerning this matter
Sincerely,
v
el,
1 I re• on
strict Manager
Ted Tyndall, Assistant Director (DCM)
Merrie Jo Alcoke, AG's Office
Phillip Brooks
Wes Hodges

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ eomplete items 1,2,and 3.Also complete A. Signatu -
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse X , ge nt
so that we can return the card to you. ❑Addressee
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2. Article Number 7004 2890 0002 3425 2378
(Transfer from service label)
PS Form 3811,February 2004 Domestic Return Receipt
102595-02-M-154C
U.S. Postal Service,. �� 1A
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SENDER:,COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Si ure
item 4 if Restricted Delivery is desired.• Print your name and address on the reverse X / / e' !tz3ssee
so that we can return the card to you. B. Received by(P'nted,.Name) C. ate f Delyvery
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4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Numbrfrom 7002 2410 0003 1725 8723
(transfer from service label)
PS Form 3811,August 2001 Domestic Retum Receipt 102595-02-M-1540
I
I
SENDgR: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
A. Signature. • Complet6 items 1,2,and 3.Also complete // CI Agent
item 4 if Restricted Delivery is desired. ❑Addressee
• Print your name and address on the reverse ��.-..
so that we can return the card to you. B. Receiv d by(Printed Name) C. Date of Del' ery
• Attach this card to the back of the mailpiece, D a pa,
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