22-015 (4) COMPLETE
SENDER: COMPLETE THIS SECTION■ Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. X ❑Agent
■ Print your name and address on the reverse ❑Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑ No
'0' 3. Service Type
❑Certified Mail ❑Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2.,Article Number 7012 3050 0000 8965 7713
(Transfer from
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
e
0 061.4 8
RETURN IN 5 DAYS 7 012 0 0000 8 9 6 5 7 13
DEPARTMENT OF BUILDING INSPECTIONS
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212 Main St. Rm. 100 • Municipal Building
Northampton, MA 01060-3189 °
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Florence MA 010
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