20091109 Ver 1_Certified Return Receipt_20091223

■ 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:
� Mr. Eric Keravuori '�
Town OF R�alce Forest
4011 Elm Avenue
� Wake Forest, NC 27587
�. 09-1109 ----- --- -
. . . .
A. Signature �i, ,
'/'/ �Agent
X ` •'y�' � o O Addressee
B. Received by (Prin e Name) C. Date of Delivery
�(�ifi�FF�� �2'� 3
D. Is delivery address differeM from item 1? ❑ Yes
If YES, enter delivery address below: �-No
`
3. S�/1ce Type
/� Certified Mail
❑ Registered
❑ Insured Mail
�ress Mail
Retum Receipt for Merchandise
❑ C.O.D.
4. Restricted Deliver�t (Extra Fee) ❑ Yes
2. Art�c�e Number -- -- :7 � 0 7" 2 5 6 0 � 0 01 �:13 81 6�10 2�': I
(fransfer from service la
PS Form $811. , February 2004 Domestic Retum Receipt iozsss-o2-nn-tsao

UNITED STATES POSTAL SERVI��' j'��° �'�� °;'� ��
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• Sender: Please print your name, address, and ZIP+4 in this box •
NC DENR DiVIS10N 01' WATER QUALITY i
40l OVERSIGH'C/EXPRESS IINIT �
2321 CRABTREE f30ULGVARD, SUITE 250
RALEIGf-I, NC 27604
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