HomeMy WebLinkAbout3.01 Public Notice 12.05.2005PUBLIC NOTICE
TAKE NOTICE that EnCana Oil and Gas (USA), Inc. has applied to the Board of County
Commissioners, Garfield County, State of Colorado, for a Special Use Permit to allow a "Centralized
Exploration and Production Waste Facility" in connection with the following described property
situated in the County of Garfield, State of Colorado; to -wit:
Legal Description: See attached Legal Description.
Practical Description: . Approximately one (1) mile southeast of the Garfield County Airport.
Pursuant to §3.02.03 and §5.03 of the Garfield County Zoning Resolution of 1978 as amended;
the applicant is requesting a Special Use Permit for "Storage, Processing, and Material
Handling of Natural Resources" for a Centralized Exploration and Production Waste Facility
on an 8.48 acre property owned by Encana Oil and Gas (USA), Inc. The requested use is for a
bioremediation land -farm to treat soils that have been contaminated with petroleum
hydrocarbons.
All persons affected by the proposed special use permit are invited to appear and state their views,
protests or support. If you can not appear personally at such hearing, then you are urged to state your
views by letter, as the Board of County Commissioners will give consideration to the comments of
surrounding property owners, and others affected, in deciding whether to grant or deny the request
for the special use permit. The application may be reviewed at the office of the Planning Department
located at 108 8th Street, Suite 201, Garfield County P1a7a Building, Glenwood Springs, Colorado
between the hours of 8:30 a.m. and 5:00 p.m., Monday through Friday.
A Board of County Commission public hearing on this application has been scheduled for the
5th day of December 2005, at 1:15 p.m., in the County Commissioners Meeting Room, Garfield
County Plaza Building 108 8th Street, Glenwood Springs, Colorado.
Planning Department
Garfield County
NOTICE
TAKE NOTICE
That ECANA OIL. ` GAS
has a pplied to the
4.564Eis or ectvoir7. eem of, 3 .01) it#PAS
Garfield, County
pursuant to
SteriDAsS 510S 3.OL.o3 DF Tim lAiGiELb Cbwtirl'
gtt O7io't or / 77e , Rs rtiricArze`n
to allo*
pECI4,L USE PFiCwrr.rT ret+t GEA►7i44LI2TD
on this property.
A public #44g/4/6
will be held in the 40mwrsvnNseg 1414`6-9744 ke:o1201
on this application
106 Ste` sr
Glenwood Springs, Colorado
on
PEZElavief
(date)
at
(time)
1-1/5
Date Notice Was Posted:
By:r
For additional information, contact the
PM NA//A/6 DEpAers4E-Air
at 4170-49'1ff- eZt'z or , 108 8th St.
Suite 2L1 , Glenwood Springs, CO 81601
State PROOF OF PUBLICATION
TAKE NOTICE Cthat EnCana Oil
and Gas (USA), Inc. has applied
to the Planning Commissioners,
Garfield County, State of Colo -
redo, for a Special Use Permit
to allow a "Centralized Explorer
lion and Production Waste Facil-
ity" In•.connection Wlth the fel-
lowing.described property
situated In the County of Gar-
field, State of Colorado; to-wit:
Legal Description:
SECT; TWN RNG: "19.6.92
.DESC.: LOT 3(48.42AC), NWSE .
Practical Descriptfon:Ap roxi-
meteiy one -(11 mile southeast of •
the Garfield County Airport.
Pursuant to 13,02.43 and §5.03.
of the Garfield County Zoning
Resolution o0878 as amended;
the applleant Is requesting a
Speel9T Use.permltfor "Storage,
Proceasingg',,and Material Han-
dling of Natural Reedurces" for
a Centralized Exploration .and
Production Waste Facility on an
8.48 acre property owned by
EnCana Oil epd Gas (USA), Mc,
The requested use Is for a
bloremedlatfon land -farm to treat -
soils that have been contami-
nated with petroleum hydr4car-
bans.
All persons effected py the pro.
posed special use permit are in-
- Oiled to appear and slate their
views, protests or support. If-
you can not appear personally
at such hearing, then you are
'urged to state your views by
fetter; as the Planning Commis-
sioners will give consideration to •
the comments of surrounding
property owners, and others af-
fected, in deciding whether to
grant or deny the request for the
special use permit. The appli-
catiOn may be reviewed at the
of lice of The Planning Depart-
ment located at 108 8th Street,
Suite 201; Garlleld County Plaza
Building, Glenwood Springs
Colorado between the hours of.
8':30 a.m. and.5:00, p.m., Monday
through Friday.. -
A planning Commission public
hearing oh this application has
been scheduiad for the 12th day`.
of October 2005, at 6:50 p.m., In
- the. County Commissioners
Meeting Room, Garfield County
Plaza 9uliding.108 8th Street,
.Glenwood Springs, Colorado; •
Planning Department
Garfield County
Published August 29, 2005
STATE OF COLORADO
County of (Mesa)
Karen Wells
Being duly sworn, says that I am Legal Secretary of
The Daily Sentinel, a daily newspaper, published and duly printed in
Grand Junction, Colorado in said County and State; that said
newspaper has a general circulation in said County and has been
continuously and uninterruptedly published therein, during a period of
at least fifty -two consecutive weeks next prior to the first publication
of the annexed notice; that said newspaper is a newspaper within the
meaning of the act of the general Assembly of the State of Colorado,
entitled "An Act to regulate the printing of legal notices and
advertisements," and amendments thereto; that the notice of which
the annexed is a printed copy taken from said newspaper, was published
in said newspaper, and in the regular and entire issue of every number
thereof, once a week for I successive week:
that said notice was so published in said newspaper proper and not in
any supplement thereof, and that first publication of said notice as
aforesaid, was on the 29th day of August , 2005,
and the last, on the 29th day of August . 2005.
Subscribed and sworn to before me, this - day of
t20 c'
vi / f!i /,alytk.�a
i • r mat
arh
My Corrrmissibn Expire;11108126Q
RITA M.
w.vrsON :i ,
or
PUBLIC NOTICE
TAKE NOTICE that EnCana Oil and Gas (USA)
Inc. has applied to the Planning Commissioners,
Garfield County, State of Colorado, for a Special
Use Permit, to allow a "Centralized Exploration and
Production Waste Facility" In connection with the
following described property situated in the County
of Garfield, State of Colorado; to wit:
Legal Description; SECT, TWN, RNG: 196.92
DESC: LOT 3(46,42 AC), NWSE
Practical Descrigigp; Approximately one (1) mile
southeast of the Garfield County Airport.
Pursuant to §3.02.03 95.03 of the Garfield
County Zoning Resolution of 1978 as amended;
the applicant Is requesting a Special Use Per-
mit for "Storage, Processing, and Material Han -
dling of Natural Resources' for a "Centralized
Exploration and Production Waste Facility on
an 6.48 acre property owned by Encena Oil and
Gas (USA) Inc. The requested use Is for a bio-
remedlation land -farm to treat soils that have
been contaminated with petroleum hydrocar-
bons.
All persons affected by the proposed Special Use
Permit are invited to appear and state their views,
protests or support. If you can not appear person-
ally at such hearing, then you are urged to state
your views by letter, as the Planning Commission-
ers will give consideration to the comments of sur-
rounding property owners, and others affected, In
deciding whether to grant or deny the request for
the special use permit. The application may be re-
viewed at the office of the Planning Department 10-
cated at 108 8th Street, Suite 201, Garfield County
Plaza Building, Glenwood Springs, Colorado be-
tween the hours o18 :30 am and 5:00 pm, Monday
Through Friday.
A public hearing on the application has been
scheduled for the 12th day of October 2005, at
6:30 pm, in the County Commissioners Meeting
Room, Garfield County Plaza Building, 108 8th
Street, Glenwood Springs, Colorado.
Planning Department
Garfield County
Published in the Glenwood Springs Post Independ-
ent August 29, 2005
PROOF OF PUBLICATION
GLENWOOD SPRINGS POST INDEPENDENT
STATE OF COLORADO, COUNTY OF GARFIELD (ss)
?).&1A-r1
c-r
37493
, do solemnly swear that I am
of THE GLENWOOD SPRINGS POST INDEPENDENT;
that the same is a weekly newspaper printed, in whole or in part, and
published in the County of Garfield, State of Colorado and has a general
circulation therein; that said newspaper has been published continuously and
uninterruptedly in said County of Garfield for a period of more than fifty -two
consecutive weeks next prior to the first publication of the annexed legal
notice or advertisement; that said newspaper has been admitted to the United
States mails as second -class matter under the provisions of the Act of March 3,
1879, or any amendments thereof, and that said newspaper is a weekly
newspaper duly qualified for publishing legal notices and advertisements
within the meaning of the laws of the State of Colorado.
That the annexed legal notice or advertisement was published in the regular
and entire issue of every number of said weekly newspaper for the period of
1 consecutive insertions; and tha the first publication of said notice was
in the issue of said newspaper dated
A.D., 20
and the st publication of said notit was the issue of said newspaper
dated fa v al- A.D., 20 QS
In witness whereof I have hereunto set my hand this 0q9 day
D,, 20
General Manager/PruMiSier
Subscribed and sworn to before ublic in . for the 5,o,iffy of
Garfield, State of Colorado, this
A.D., 20
(SEAL)
ommission expires
lic Signature
My Commission F.Ofes Pilt2009
2014 Grand Avenue Glenwood Springs, CO 81601
NOTICE
TAKE NOTICE
That 419h aL _6i5.) Ipk
has a plied to the
Garfield. County
pursuant to
03 4s1 S -03 o 7yE
L f•rrax znaaiA4 irsa ,cswiy .L mzt s84
to allow
jczAte.._zzie____deike_ceif *ow
or. :`ii,;, properi.
A public tf ARtM4 _ _ -. - on this application
will be held sn the 1121 i2_,Lsg ]..iita(f`
kcCrivi_ V* se
Glenwo'4d Spring, Colorado
on
b tu. "'' L2"r" •
at
L. 30 t„i
Pr
Date Notice Was Posted . ,kg,rrs,f
By: -sl er a. 6/ f
For additional information, contact the
at qe eii!2._ _ or _ ___ 109 8th $t.
Suite 20 -- - - -___ , Glenwood Springs. CO 81501
- - f
NOTICE
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CERTIFIED MAIL,, RECEIPT
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0.37
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(Endorsement Required)
Restricted Delivery Foe
(Endorsement Required)
Total Postage & Fees
or PO sox No.
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08/23/05
See Reverse for Instructions
SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
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item 4 if Restricted Delivery is desired.
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❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
❑ Yes
2. Article Number
(Transfer from service label)
7003 3110 0004 78213 6572
PS Form 3811 , February 2004 y,t
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08/23/05
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SENDER: COMPLETE THIS SECTION
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item 4 if Restricted Delivery is desired.
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to that we can return the card to you.
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3. Service Type
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❑ Retum Receipt for Merchandise
C.Q.D.
4. Restricted Delivery? (Extra Fee)
❑ Yes
2. Article Number
(Transfer from service label)
7903 3110 0004 7828 65%
PS Form 3811, February 2004 Domestic Return Receipt
102595 -02 -M -1540
U.S. Postal ServiceTr„
CERTIFIED MAILTM RECEIPT
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For delivery information visit our website at www.usps.comr
Postage
Certified Fee
Return Reciept Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees
0.37
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UNIT III: 0543
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08/23/05
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SENDER: COMPLETE TI-11S SECTION
COMPLETE THIS SECTION ON DELIVERY
• Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
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• Attach this card to the back of the mailpiece,
or on the front if space permits.
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4. Restricted Delivery? (Extra Fee)
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2. Article Number
(Transfer from service label)
7005 5110 0004 7858 6589
PS Form 3811, February 2004 �• � Domestic Return Receipt
102595 -02 -M -1549
7003 3110
U.S. Postal Service,„
CERTIFIED MAILTM RECEIPT
Domestic Mail (?nf ; No Insurance Coverage Provided)
For delivery information visit our website at www.usps.com
R . LO n i C I A L USE
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Certified Fee
Return Reclept Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
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$
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2.30
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Clerk: BU 30
08/23/05
Sent To
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PS Form 3800. June 2002
CO \L
See Reverse for Instructions
SENDER: COMPLETE THIS SECTION
• 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.
IN Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
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3. Service Type
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4. Restricted Delivery? (Extra Fee)
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2. Article Number
(Transfer from service label)
7003 3110 0004 7828 6602
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Clerk: BVFRMO
08/23/05
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SENDER: COMPLETE THIS SECTION
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item 4 if Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
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or on the front if space permits.
❑ Agent
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C. Date =f Delivery
1. Article Addressed to:
D. Is delivery address diffeV't from item ? / Yes
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3. Service Type
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2. Article Number
(Transfer from service label)
7000 3110 0004 7808 6619
PS Form 3811, February 2004 650,41 Domestic Return Receipt
102595 -02 -M -1540;
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08/23/05
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SENDER: COMPLETE THIS SECTION
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so that we can return the card to you.
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or on the front if space permits.
1. Article Addressed to:
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2. Article Number
(Transfer from service label)
7003 2110 0004 7828 6626
PS Form 3811, February 2004 f • `L Domestic Return Receipt
102595 -02 -M -154,0
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U.S. Postal ServiceT,.,
CERTIFIED MAIL,., RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
For delivery information visit our website at www.usps.camz,
See Reverse for instructions
SENDER: COMPLETE THIS SECTION
• 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.
1. Article Addressed to:
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COMPLETE THIS SECTION ON DELIVERY
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❑ Agent
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C. Date of Delivery
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2. Article Number
(Transfer from service label)
7003 3110 0004 7838 6633
PS Form 3811, February 2004 Domestic Return Receipt
102595 -02 -M -1540
0004 7828
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U.S. Postal Service,.,
CERTIFIED MAILTM RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
For delivery information visit our website at www.usps.coma
siCIFF651CIAL USE
Postage
Certified Fee
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Restricted Delivery Fee
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Total Postage & Fees
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Clerk: EVFRMO
08/23/05
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See Reverse for Instructions
SENDER: COMPLETE THIS SECTION
• 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.
1. Article Addressed to:
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2. Article Number
(Transfer from service label)
COMPLETE THIS SECTION ON DELIVERY
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❑ Agent
'❑ Addressee
C. Date of Delivery
"C5
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
Certified Mail ❑ Express Mail
Registered ❑ Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7003 3110 0004 7808 6640
PS Form 3811, February 2004 '.'11±."41 Domestic Return Receipt
102595-02 -M -1540
U.S. Postal Servicem,
CERTIFIED MAIL,. RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
ormation visit our website at www.usps.coms
Postage
Certified Fee
Return Rec. lept Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees
1.75
UNIT 111: 0543
Postmark
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Clerk: RVERMt?
08/23/05
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Cltf, State. ZI
PS Form 3800, June 2002.
`ts
See Reverse for Instructions
SENDER: COMPLETE THIS SECTION
• 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.
a Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
C Q.
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1-kiA- , 07- i 313
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COMPLETE THIS SECTION ON DELIVERY
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B. Received by (Printed Name)
4-wh4 ----ft ' G� 775
❑ Agent
❑ Addressee
C. Date
D -live
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D. Is delivery address different from item 1? ❑ 'uses
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Service Type
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❑ Registered
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0 Return Receipt for Merchandise
❑ C.O.D.
4. Restricted Delivery? (Extra fee}
❑ Yes
2. Article Number
(Transfer from service label)
7003 3110 0004 7838 6637
PS Form 3811, February 2004 \ Domestic Return Receipt
102595 -02 -M -1540
Wagon Wheel Consulting
111 East 3rd, Ste. 213
Rifle, CO 81650
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7003 311,,
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7003 31 1 0 0004 7828 6664
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Aspen, CO 81611 _ - _.
81611
U.S. POSTAGE
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Postage
Certified Fee
Return Reciept Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees
0.37
230
1.75
4.42
UNIT ID: 0543:
Posimat
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Clerk: DVF01
08/23/05.
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PS Form 3800, June 2002 See Reverse for Instructions
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1 Return Reclept Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
U.S. Postal Service,.
CERTIFIED MAILmr RECEIPT
D•mestic Mail Onl • No Insurance Coverage Provided)
For delivery information visit our website at www.usps.come
SPRIN6S:t8 81641
Postage
Certified Fee
u'1
rR
Total Postage & Fees
0.37
2.30
1.75
S
4.42
IT ID: 0543
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48!23/
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orrPOBo r. N. J U ] CJ � ? /a o �3� P -i c 1
or Pr) Box No.
City, State, ZIP+4
SSm
PS Form 3800, June 2002
r
See Reverse for Instructions
SENDER: COMPLETE THIS SECTION
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.
I. Article Addressed to:
COMPLETE THIS SECTION ON DELIVERY
A. Signatur"
x
B. Received by ( Printed Name)
L�'AgenY
0 Addressee
C. D- e of D-livery
PD Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
23
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3. Service Type
El Certified Mail
❑ Registered
❑ Insured Mail
11S
❑ Express Mail
0 Return Receipt for Merchandise
❑ G.O.D.
4. Restricted Delivery? (Extra Fee)
❑ Yes
2. Article Number
(Transfer from service Labe°
7004 1353 0004 364 7723
PS Form 3811, February 2004 ;- t Domestic Return Receipt
102595.02 -M -1540
U. . • ostal Service,.
CERTIFIED MAILTM RECEIPT
(Domestic Mail Only; No Insurance Covera • e Provided
For delivery information visit our website at www.usps.com..L,„
ROA RetoC 1AL USE
Postage
Certified Fee
Return Reclept Fee
(Endorsement Required)
Restricted Delivery Fee
,-q (Endorsement Required)
r-1
Trl
N
Total Postage & Fees
$
0.37
2.30
1.75
4.42
UNIT ID: 0543
Postmark
Clerk: BVFRMO
08/23/057
To
01,0_,Qc :7
solagAmha;
or PO Box No.
My, State, ZiP+4
lj
0
PS Form 3800, June 2002
Ca 1(0 50
See Reverse for Instructions
DER: COMPLETE THIS SECTION
M 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.
1. Article Addressed to:
1-Lu.
"R‘Lizt.0 , C_,C) 2.)1,65C
COMPLETE THIS SECTION ON DELIVERY
A. Signature
Agent
X (.5‘,497? /44.4. Addressee
B. Received by (Printed Name) U
C. Date of Delivery
D. Is delivery address different from item 1? 0 Yes
If YES, enter delivery address below: 0 No
3. Service Type
p" Certified Mail
0 Registered
0 Insured Mail
0 Express Mail
0 Return Receipt for Merchandise
0 C.O.D.
4. Restricted Delivery? (Extra Fee) 0 Yes
2. Article Number
(Transfer from service label)
7003 3110 0004 7828 6718
PS Form 3811, February 2004 cs501,1( Domestic Return Receipt
102595-02-M-1540
2.30/
7828 6701
7203 3110
U.S. Postal Service,:,
CERTIFIED MAIL,, RECEIPT
{Domestic Mail Only; No Insurance Coverage Provided)
For delivery information visit our website at www.usps.come
FIA
Postage
Codified Fee
Return Reelepl Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees
0.37
4.42
USE
LIWIT ID: 0543
Ct toJ
\/,?41)1
Apt. No.;
ur PO smr 1'41 i i.�. ..-r�-
Citj Sri, ZIP44
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PS Farm 3800, June 2002 See Reverse for Instructions
SENDER: COMPLETE THIS SECTION
• 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.
1. Article Addressed to:
$`-kC)-+%"
COMPLETE THIS SECTION ON DELIVERY
A Sign tire
X
/2 ❑ Agent
El Addressee
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
Certified Mail
❑ Registered
❑ Insured Mail
❑ Express Mail
❑ Return Receipt for Merchandise
CI C.O.D.
4. Restricted Delivery'? (Extra Fee)
❑ Yes
2. Article Number
(Transfer from service label)
7003 3110 0024 7828 6701
PS Form 3811, February 2004 e sc Domestic Return Receipt
102595 -02 -M -1540;
Sent To
34 01
erreet, Apt: nfo.; e
or P0 Sax Na 7 Q _. ,. _ . s Q- L
City, State, + • _. i _
U.S. Postal Service,r.,
CERTIFIED MAIL, RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
For delivery information visit our website at www.usps.comtr
0.37
USE
PS Form 3800, June 2002
See Reverse for Instructions
7003 3110
SENDER: COMPLETE THIS SECTION
• 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.
II Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
3\Q\ R
SW 0.0
COMPLETE THIS SECTION ON DELIVERY
A. Signature
X
Ar
' ❑ F
C. Date
i
D. Is delivery address different from item 1? [
If YES, enter delivery address below: L
S. Service Type
GE l Certified Mail
❑ Registered
❑ Insured Mail
❑ Express Mail
❑ Return Receipt for Meg
❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
2. Article Number
(Transfer from service label)
7003 3110 0004 7828 6695
PS Form 3811, February 2004 Domestic Return Receipt
9025354
U.S. Postal Service,.
CERTIFIED MAIL. RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
For delivery information visit our website at www.uespsco
Postage
Certified Fee
Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Cierteall3W109
6123/05
Total Postage & Fees
See Reverse for Instructions
SENDER: COMPLETE THIS SECTION
• 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.
1. Article Addressed to:
1,
c , Q_,o (61 ) 5 u
COMPLETE THIS SECTION ON DELIVERY
A. Signatu
X
Agent
ressee
Date of Delivery
is delivery address differs from item 1? ❑ Yes
if YES, enter delivery address below: ❑ No
3. Service Type
Q Certified Mail
❑ Registered
❑ Insured Mail
❑ Express Mail
❑ Return Receipt for Merchandise
❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
❑ Yes
2. Article Number
(Transfer from service label)
7003 3110 0004 7828 6688
PS Form 3811, February 2004 �c4 Domestic Return Receipt
1025$S-02 -M -1540