20071632 Ver 1_Certified Return Receipt_20071006

^ Complete items 1, ~, and 3.AIso 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:
~71Ty ~10a111110
581 Lindron Avenue
Smithtown,New YorK 11787
DWQ# 07-1632-Iredell
<i7iL41~I~1~/CIL~Y~~YCi~ildl~7~~D/~a'
A. Si n~tUre
`Z ~G%°Z ^ Agent
/ ^ Addressee
B v ,by Punted Name,L_ C. Date of elivery
D. Is delivery address different from item 17 ^ Yes
If YES, enter delivery address below: ^ No
3. Service Type
Certified Mail ^ Express Mail
Registered Retum Receipt for Merchandise
^ Insured Mail ^ C.O.D.
4. Restricted Delivery?(Extra Fee) ^ Yes
2. Article Number
(Transfer from service label) 7 0 7 ~ 71, 0 0 0 4 6 7 4 0 19 3 D
PS Form 3811, February 2004 Domestic Return Receipt io2sss-o~awt trxao

UNITED STATED'~ir~ .~'G147~^'~~,"'~ "~" ~ ' :.~''
.,~
• Sender: Please print your name, address, and ZIP+4 in this box •
NC DENR DIVISION OF W.~1TGR QUt1L1"I~Y
401 OVERS[GH"f/EXPRESS UNIT
2321 CRABTREG BOULEVARD, SUI"1'E 2~0
RALEIGI I, NC 27604
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