HomeMy WebLinkAboutCertified Mail Receipt - OT General - 3/8/1982 I
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UNITED STATES POSTAL SERVICE First-Class Mail
Postage&Fees Paid
USPS
Permit No.G-10
We Print your name, address, and ZIP Code in this box • I
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Mason County Dept. of Health Services
Office of Water Quality j
410 N. 4th - P. 0. Box 1666 I
Shelton, WA 98584-5001 t�-tIV1_-L
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c'• SENDER:
■Complete items 1 and/or 2 for additional services. I also Wish to receive the I
W ■Complete items 3,4a,and 4b. following services(for an ]I
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■Print your name and address on the reverse of this form so that we can return this extra fee):
card to you. ai
d ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address
permit.
y ■Wnte*Return Receipt Requested'on the mailpiece below the article number. Z ❑ Restricted Delivery to
r -The Return Receipt will show to whom the article was delivered and the date I
c delivered. Consult postmaster for fee.
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a 3.Article Addressed to: 4a.ArticleCMC
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E 4b.Service Type
0 / q 33d ❑ Registered Certified
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�i3lo� ❑ Express Me+-� ❑ Insured N
❑ Retum Receipt for Merchandise El COD
a 7. Date of Delivery
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D 5. Received By: (Print Name) 8.AddressdLrs Alldress(Only if requested I
w and fee is paid) r
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6.Signature: (Addressee or Agent)
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y PS Form 3811, December 1994 Domestic Return Receipt
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