23D-103 P 489 93f 853
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for International Mail(See reverse)
Sent to
Dr. Katherine Hruby
Street&Number
23 Nutting Avenue
Post Office,State,&ZIP Code
Northampton, MA 01060 4
Postage $
Certified Fee CT
Spedal Delivery Fee �1 f
Restricted Delivery Fee S el
8)., Return Receipt Showing to
Whom: 'ate My-e?Erd
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Stick postage stamps to article to cover First-Class postage,certified mail fee,and
charges for any selected optional services(See front).
1. If you want this receipt postmarked, stick the gummed stub to the right of the return
address leaving the receipt attached, and present the article at a post office service a
window or hand it to your rural carrier(no extra charge).
cb.., ff'tt i .. want this receipt postmarked,stick the gummed stub to the right of the io
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'refit 1i ,.,' -article,date,detactk.nd retain the receipt,and mail the article.
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If you wan - - - receipt,write the certified mail number and your name and address °'
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0et , Form 3811,and attach it to the front of the article by means of the
,•` -, permits. Otherwise,affix to back of article. Endorse front of article n
RN • C. ;04 QUESTED adjacent to the number. Q
..,If you ery restricted to the addressee, or to an authorized agent of the O
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addre ;. '1• •RESTRICTED DELIVERY on the front of the article. M
5. Enter fees for the services requested in the appropriate spaces on the front of this E
receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti
6. Save this receipt and present it if you make an inquiry. d
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°' SENDER: . Z
a 3 /t,V I also wish to receive the
y • Complete items 1 and/or 2 for additional services.
41 • Complete items 3,and 4a&b. following services (for an extra N
` • Print your name and address on the reverse of this form so that y:, _ n fee):
m return this card to you.
y • Attach this form to the front of the mailpiece,or on the back if space 1. El Addressee's Address y
does not permit. }
a) :6.Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery C
*" • The Return Receipt will show to whom the article was delivered and the date U
C delivered. Consult postmaster for fee. a
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'a 3. Article Addressed to: 4a. Article Number
P489931853
Ti Dr. Katherine Hruby 4b. Service Type a)
0E 2.3 Nutting Avenue ❑ Registered ❑ Insured
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Northampton, MA 01060 Z Certified ❑ COD
w ❑ Express Mail j Return Receipt for =
EC / / Merchandise L
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��' 7. Date of Deli wry
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x5. Signature (Addressee 8. Addressee's Address (Only if requested.
n and fee is paid) c
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6. Signature (Agent) I-
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> PS Form 3811, December 1991 trU.S.GPO:1993-352-714 DOMESTIC RETURN RECEIPT
UNITED STATES POSTAL SERVICE 111111
Official Business PENALTY FOR PRIVATE
USE TO AVOID PAYMENT U.S.MAIL
OF POSTAGE, $300
Print your name, address and ZIP Code here
City of Northampton Building Dept.
212 Main Street
Northampton, MA 01060