20071692 Ver 1_Certified Return Receipt_20071009

^ Complete items 7, 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:
Lacy S. Hodgin
234 Canal Circle
Semora,NC 27343
DWQ# 07-1692-Person
A. Signa re
~ ^ Agent
X ,~ t /-~ ~~~ f i_ ^ Addressee
B Rec rved by (Prin ed Name) C. Date of Delivery
D. Is delivery address different tram item 1? ^ Yes
If YES, enter delivery address below: ^ No
3. Service Type
Certified Mail F~cpress Mail
^ Registered Retum Receipt for Merchandise
^ Insured Mail C.O.D.
4. Restricted Delivery? (Extra Fee) ^ Yes
i. ArtlcleN ~ 707 X710 ~0~4 674 2272
(Transfer

UNITED STATES ~R~iv~~~l.~i~>c~ti._~4 x4~'.:: `t.
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• Sender: Please print your name, address, and ZIP+4 n this box •
NC DF,NR Division of Water Quality
401 Oversibht/Express Unit
2321 G•abtree Boulevard, Suite 250
Kaleigh, NC 27604
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