HomeMy WebLinkAbout12-79 Alfred & Annie Hicks Garage (Fronted Alignment) - Backfiler-
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Third Cut #953R
t. CONDITIONAL USE PERMIT NO. 012-79
Alfred & Annie Hicks
zoned A-2/3.448 acres
Location:
Adjacent Land
Use and Zoning:
Proposed Use &
On Route 628 approximately 2100' North of intersection Route.
629 East. (Please see attached map_X
Farming, A-2.
Improvement: Garage for front-end alignment and wheel balancing shop_ This
is a one person business, with no storage of vehicles over-
night. No new construction proposed Home occupation
Review Comments: Frederick -Winchester Health Department - Satisfactory for
one person only.
Virginia Deparment of Highways and Transporation - No
objections.
Department of Public Works- O.K.
Department of Inspections -.Existing garage requires no
additional code requirements - 0'.K_ to prc,:.:�eed_
Zoning - As per the Commonwealth Attorney's suggestion, this
could be approved as a home occupation in an out -building -
Planning - Comprehensive Plan suggests agricultural. The use
currently exists in violation of .the zoning ordinance_
Staff Recommendations:
Staff recommends approval of a one-year, non -transferable permit with the -
further provisions that no one be employed =other than resident family members`;,•.
that there be no outside storage and the .the hours of operation be daylight hours.:.
Planning Commission Recommendations:
The Planning Commission unanimously recommends approval with the conditions
that the permit be for one year, non -transferable, that no one be employed but
resident family members, that there be no outside storage and hours of operation
be daylight hours. It was noted during Planning Commission discussionthat this
use has presented no problem in the past.
�Orvarhlvenf n ��tzzntn xY �` Q�rQ.l� xttQtt�t
P. O. Box Got
JOHN RILEY D COURT SQUARE
PLANNING 13IRECiOR VI rmrj3E87ER. VIRGIN 22601
January 24, 1980
Mr. &Mrs. Alfred L. Hicks
Route 4, Box 466
Winchester, Virginia 22601
Dear Mr. & Mrs. Hicks:
This letter is to inform you that your conditional use permit
for a home occupation/front-end alignment and wheel balancing
shop has been reviewed administratively and renewed for one year
effective January, 1980.
This permit will be automatically reviewed each year during the
month of January.
If you have any questions;-r-p`leasedo not hesitate to contact this
office.
Sincerely,
John R, Riley,�Yirector
JRR:bjs
cc: Mr. Stan Pangle, Interim County Administrator
703/662-4532
R
No. Zoning Application for CONDITIONAL USE PERMIT
Date August 15, 1978 to COUNTY of FREDERICK, VIRGINIA
Q�
--------------------------------------------------------------------------------------------------
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I (we), the undersigned, do hereby respectfully make application for a CONDITIONAL USE
PERMIT, and in support of this application, the following facts are shown:
1. The Applicants Alfred L. Hicks and Annie Jane Hicks *xx(are) the :txsxwK (owner.4
of property situated at Relief, Virginia (Five miles from wards Plaza South on
Middle Road
fronting Route 628
The exact Legal Description (Lot, Block and Tract) of said property being See attached
Survey
2. The type of use and/or improvements proposed are as follows: Desires to use present
Garage building for Front -End Alignment and Wheel Balancing Shop. This is one
person business, with no storage of vehicles overnight.
Aow►F c
3. New buildings to be constructed are as follows:
4. Additions to existing buildings are as follows:
N/A
5. I (we), accept and agree to comply with any conditions required by the Board of Super-
visors of the County of Frederick, Virginia.
- . % ..I I /'1/ / , /
SIGNATURE:
ADDRESS:
------------------------------
------------------------------
TO BE COMPLETED BY THE ZONING ADMINISTRATOR:
6. Zoning of the property is
7. Zoning of the surrounding area is
%
6. Please attach a sketch of the property showing existing and proposed buildings.
7. I (we), accept and agree to comply with any conditions required by the Board of Super-
visors of the County of Frederick, Virginia, and authorize the County to go upon the
property for the purpose of making site inspections.
SIGNATURE:
ADDRESS:
By:
The CONDITIONAL USE PERMIT Application of
was reviewed by the PLANNING COMMISSION on (date)
with the following RECOMMENDATION(s) to the Governing Body:
APPROVAL with the following condition(s) per the list below:
- OR -
DENIAL for the following reason(s) per the list below: /^f
By: i
Secretary, Planning Commission for he County of Frederick, Virginia
-------------------------------------------------------------------------------------------
The CONDITIONAL USE PERMIT Application of otv::�' �- � & L
0 � k OL- 7
was reviewed by the BOARD OF SUPERVISORS (Governing Body) on (date) " ./ I, / ? ZZ
and took the following action:
APPROVED with the following condition(s) per the list below:
-OR-
DENIED for the following reason(s) per the list below: %j
By:
Zoning Code Administrator for
Board of Supervisors of the County of Frederick, Virginia
No.
Date
Property Identification Number
Magisterial District
Zoning Application for CONDITIONAL USE PERMIT
to COUNTY OF FREDERICK, VIRGINIA
I (we), the undersigned, do hereby respectfully make application for a CONDITIONAL USE
PERMIT, and in support of this application, the following facts are shown:
1, The applicant is (are) the owner (lessee or contract
holder) of property situated at
fronting state route consisting of acres, and described in deed book
page
2. The type of use and/or improvements proposed are as follows:
3. New buildings to be constructed are as follows:
C 4. Additions to existing buildings are as follows:
5. The following are all of the individuals, firms, or corporations owning property adjacent
to both sides and rear, and the property in front of (across street from) the property.
(Use additional pages if necessary.)
NAME
Numbers
COMPLETE MAILING ADDRESS
(Street, Route, Box, Etc. Nos.)
PARCEL TAX MAP
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(MUTE: Information may be obtained from the Office of the Commissioner of Revenue.)
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GRIM LOT
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OTHER LAND
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The above Plat is a Survey of a Portion of the Land Conveyed to
Carl Hicks, The said Portion fronts the southeastern boundary line of
the Middle Road - Rt. 628, and lies in Opequon District, Frederick
County, Virginias
Beginning at an iron pin in the southeastern boundary line of the
Middle Road, a corner to the Lot Conveyed by William H. Bly to Molly
Anne Grim (26 May 1964 - D. Bo 300 P. 4), running with the said south-
eastern boundary line S 330 lit w - 150.00 f t. to an iron pin corner to
the retained portion; thence with the two following lines of the said
Other Land s 490 211 E - 585,76 f t, to an iron pin; thence N 330 lit S
150,00 fto to an iron pin in the southwestern line of the Snapp Land;
thence with the said line and with the southwestern line of the said
Grim Lot N 490 211 w - 585,76 ft. to the beginning,
Containing - - 2.00 Acreso �?ea 0,
Surveyed - - - June 4, 1964o
LEE A. EBBRT,
Certified Land Surve or,
Comm. of Virginia # 84.
VtRGtj, A FREDERICK COUNTY, $a- I q �o T
This instrument of writtng was produced to me on the
day - —I) � �I
ar -5
7. A. 14. , Qnd with cettific6te f wt.d *w,4o wed! admMed
to rdeord, ! _ Z D + 7
6�11-2 _ ;��
RETAINED PORTION
PARCEL I — D.B. 338 - P.438 1 N
Q �
7 IRON PIN IRON PIN 4
7 N 49' 21' W -- 505.86'
jZ
'Off` �J
O O ,� I. 448 AC. No,
Lei cn N t0 N w �°
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CO �.`� S490 21' E — 512.46' Z
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so.
ALFRED HICKS
2.0 AC.
D.B. 300 - P. 374
The above Plat is a Survey of the Southwestern Portion of the Land
(Parcel 1) conveyed to Alfred L. Snapp by Deed dated 10 January 1968 in
Deed Book 338 Page 438. The said Land fronts the Southeastern Boundary
Line. of The Middle Road - Rt. 628, and lies in Opequon District, Freder-
ick County, Virginia t
Beginning at an iron pin in the Southeastern Boundary Line of Rto
6280 a corner to the Alfred Hicks Land, Running with the Northeastern
Line of the said Hicks Land S 490 211 E r 512-46 ft. to a post corner
to the Alfred Lo Snapp Land (D. B. 328 Po 312); thence with the North-
western Line of the said Land N 300 121 30" E - 126.03 ft, to an iron
pin corner to the Retained Portion; thence with the Southwestern Line
of the said Other Land N 490 211 W - 505.86 ft. to an iron pin in the
Southeastern Boundary Line of Rt. 628; thence with the said Boundary
Line S 110 111 W - 125.00 ft. to the beginningo
Containing - - 1.448 Acreso
n••,veyed - - - April 23, 19680
LEE A. EBRRTj
Certified Land Surveyor,
Comm. of Virginia ## 4840
r ECE[V ED j U4 1 1 19M
H. RONALD BERG
PLANNING DIRECTOR
DOROTHEA L. STeFEN
ZONING ADMINISTRATOR
-
����r#zzt�n#
P Q_ Bctx 601
8 COURT SQUARH.
V'Vi7VC1iE5.TE1?, VjfZG.Nj,- 2-Scki
Frederick -Winchester Health Department , ATTN Joe Curley "
Va. Department of Highways & Transportation , ATTI4 R.-C. Kind
Department of Infections , ATTv Carroll Brown _
Department of Public Works , ATTN Stan Pangle
Dorothea L. Stefen, Zoning Administrator Date May 30, 1979
FROM:
SUBJECT
Review comments on XX Conditional Use Permit 5tbdiviston
m e m o r a n d u m
Rezoning Site Plant.
'7(7
Signature Date.
703/662- 532
0 0 0/�-79
H. RONALD BERG
PLANNING DIRECTOR
DOROTHEA L. STEFEN
ZONING ADMINISTRATOR
TO:
4'i rrberic 2 CluL[ntl1
39yartment of 11Ittnning anN EfrQluirmQn
m e m o r a n d u m
P. 0. Box 601
9 COURT SQUARE
WInCHI_STER, VIRGIMA 2260T
Frederick -Winchester
Health Department
, ATTN
Joe Curley
Va. Department of Highways
& Transportation
, ATTU
R.-C. King
Department of Inspections A :*7 Carroll Brown
Department of Public Works , ATILT Stan Pangle
FROM: Dorothea L. Stefen, Zoning Administrator Date May 30, 1979
SUBJECT:
Review comments on XX Conditional Use Permit
Rezoning
We are reviewing the enclosed request by Alfred & Annie Hicks
or their representative 869-1688
S,zbdivision
Site Plas
review the attached and return your comments to me by June 13, 1979
This space should be used for review comments:
Signature Date 104
7o3/sot-�:ssz
Will you please
RECEIVED MAY 3 1 1979
Dr -part enf of Planning an4 Qfr n. x�r of
H. RONALD BERG
PLANNING DIR5CTOR. 'a" 130X sa f
DOROTHEA 1_ 5TEFEN Yp a III O r a n d o m 9 COURT SQUARE..
ZONING ADMINISTRATOR Tr MICH_STHR. VIRGIMA 2Z60t
Frederick -Winchester Health Department , ATTN Joe Curley
Va. Department of Highways & Transportation , ATTN R.•C. King
Department of Inspections ,. AXr, Carroll Brown i./____
Department of Public Works , ATTN Stan Pangle.
FROM: Dorothea L: Stefen, Zoning Administrator Date "May 30,.1979
SUBJECT:
Review comments on xxConditional Use Permit Subdlvt lor..
Rezoning Sate Play .
We are reviewing the enclosed -request by Alfred.& Annie hicks
or their representative 8.69-1688 TMI, you. please-
.,',,review, the. attached and return your comments to me by June 13, 1979
This space should be used for review comments: -
1-51
Signature �2�� Date ✓ .� �' ,
7 ./ g 62-4532.
s
•
• O/e2 - 7�
H. RONALD BERG
PLANNING DIRECTOR
DOROTHEA L. STEFEN
ZONING ADMINISTRATOR
.4Xebexich &linty
Department of 3pIttntting an� PEfretapment
m e m o r a n d u m
P. 0- BOX 601
9 COURT SQUARE
WMCHESTER. VtRGINIA 2260T
TO:
Frederick -Winchester Health Department , ATTU Joe Curley ✓
Va. Department of Highways & Transportation , ATTU R.•C_ King
Department of Inspections , A:=i!f Carroll Brown
Department of Public Works , A.TTN Stan Pangle
FROM; Dorothea L. Stefen, Zoning
Administrator
Date May 30, 1979
SUBJECT:
Review comments on XX
Conditional Use
Permit Subdi_vistou
Rezoning
Site Play
We are reviewing the enclosed
request by Alfred
& Annie Hicks.
or their representative 869-1688
Will you
please
review the attached and return your comments to me by June 13, 1979
This space should be used for review comments:
/--
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4,4 f a l mn P_
or 110{ r^'� �a�, r-e
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floj�; T"hr"s �'s fair .`�y �pllr"shCjj a)('Y- e- a4_d,7OSrrlwC) r
Signature C1J- _ �✓ �_ �3__
703i662-4532
H. RONALD BERG
PLANNING DIRECTOR
DOROTHEA L. STEFEN
ZONING ADMINISTRATOR
�BqartutQn# of lRauning nub P.e£rdayxr en
P.Cy. BOX 601
9 COURT' SQUARE
VPITNCHESTER, VIRGINIA 22601
June 25, 1979'
Mr. Alfred Hicks
Route 4,. Box 465
Winchester, Virginia 22601
Dear Mr. Hicks:
-As.,I mentioned today, .it is necessary for you to post a sign on
your property advertising the July,5, 1979 public.hearing_
The sign should be 36" X 48" and be visible from the road_
Sincerely,
Dorothea L. Stefen, Acting Director
Planning and Development''
DLS:bjs .
cc J. O. Renalds, County..Administrator
C. Langdon Gordon, Planning Commission
703/662-4532
TO THE APPLICANT(s) and/or ADJOINING PROPERTY OWNERS(s):
The Application Of: Alfred L. & Annie Jane Hicks
Conditional Use Permit for:
To use present garage building for Front -End Alignment and Wheel Balancing
Shop. This is one person business, with no storage of vehicles overnight.
The Conditional Use Permit request will be considered during the Frederick
County Planning Commission's meeting at: 2:00 p.m., July 5, 1979,
in the Board of Supervisors Meeting Room, 9 Court Square, Winchester, Virginia,:
Any interested parties having questions or wishing to speak, may attend this
meeting..
Sincerely,
Dorothea L. Stefen
Zoning Administrator
cc -.J. O. Renalds, County Administrator
DLS:bsw
UNITED STATES POSTAL SERV.1p��`Tr
OFFICIAL BUSINESS
SENDER INSTRUCTION_ JU419
Print your name, address, and ZIP Code in th zpace gel'piv.
• Complete items 1, 2, and 3 on the re erse. Ig74
• Moisten gummed ends and attach to front of article
if space permits. Otherwise affix to bac of a�{ RJID'l
• Endorse article "Return Receipt Requeste''�atl�a-
cent to number.
PENALTY FOR PRIVATE
USE TO AVOID PAYMENT "
OF POSI4GFrr0�"
RETURN
TO
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(Name of Sender) —r
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(Street or P.O. Box)
\, � c P S� e Y,\; c� as 6 CJ
(City, State, and ZIP Code)
SENDER: Complete items 1. '. an,l i.
Add your address in the ''RETURN TO" space on
reverse.
1. Thllowing service is requested (check one).
LShow to whom and date delivered.......... ¢
Show to whom, date, and address of delivery.. ¢
RESTRICTED DELIVERY
Show to whom and date delivered.......... ¢
RESTRICTED DELIVERY.
Show to whom, date, and address of delivery.$—
(CONSULT POSTMASTER FOR FEES)
2. ARTICLE ADDRESSED TO:
V\A-,% -a 1. �) ),Pq % s sC�N.
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3. ARTICLE DESCRIPTION:
REGISTERED NO. CCERTIFIED NOt. INSURED NO.
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(Always obtain signature of addressee or agent)
I have received the article described above.
SIGNATURE ❑ Addressee ❑ Authorized agent
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5. DD (C plete only if requested)
6. UNABLE TO DELIVER BECAUSE:
CLERK'S
INITIALS
*GPO : 1978-272-932
No. .953764
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED —
NOT FOR INTERNATIONAL MAIL
(See Reverse)
SENT TO
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TREET AND NO.
P O.. STAT AND ZIP CODE
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POSTAGE
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POSTMARK OR DATE
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 on the left portion of the address side of
the article, leaving the receipt attached, and present the article at a post office service window or
hand it to your rural carrier. (no extra charge)
2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address
side of the article, date, detach and retain the receipt, and mail the article.
3. , If you want a return receipt, write the certified -mail number and your name and address on a return
receipt card, Form 3811, and attach it to the front of the article by means of the gummed ends if space
permits. Otherwise, afix to back of article. Endorse front of article RETURN RECEIPT REQUESTED
adjacent to the number.
4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,
endorse RESTRICTED DELIVERY on the front of the article.
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return
receipt is requested, check the applicable blocks in Item 1 of Form 3811.
6. Save this receipt and present it if you make inquiry.
SENDER: Complete item; 1. '..,nd ;.
Add your address in the "RETURN TO" space on
reverse.
1. The following service is requested (check one).
Q Show to whom and date delivered.......... C
Show to whom, date, and address of delivery..-Q
RESTRICTED DELIVERY
Show to whom and date delivered.......... e
RESTRICTED DELIVERY.
Show to whom, date, and address of del ivery.$---
(CONSULT POSTMASTER FOR FEES)
2. ARTICLE ADDRESSED TO:
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3. "ARTICLE DESCRIPTION:
REGISTERED NO. CERTIFIED NO. INSURED NO.
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(Always obtain signature of addressee or agent)
I have received the article described above.
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6. UNABLE TO DELIVER BECAUSFg
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*GPO : 1978-272-932
UNITED STATES POSTAL c
OFFICIAL BUSINESS.
SENDER INSTRUCTIO1
Print your name, address, and ZIP Code in t
• Complete items 1, 2, and 3 on the r
• Moisten gummed ends and attach to
if space permits. Otherwise affix to
• Endorse article "Return Receipt Re,
cent to number.
RETURN
TO
J�N21
PENALTY F
USE TO AV01 EN
ce
of ®tiC1e
rf rticl�.
OF POS�(ij 3fl
Dept. of Planning & Development
COUNTY OF FREDERICK, VIRGINIA
P. 0. Box 601
ame ender
601
(Street or P.O. Box)
(City, State, and ZIP Code)
No.
3153 .82
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED —
NOT FOR INTERNATIONAL MAIL
(See Reverse)
SENT TO
STREET AND NO.
y6
P.O., STATE AND ZIP COD
0c�ne -"-f-, v
POSTAGE
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RESTRICTED DELIVERY
TOTAL POSTAGE AND FEES
$
POSTMARK OR DATE
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 on the left portion of the address side of
the article, leaving the receipt attached, and present the article at a post office service window or
hand it to your rural carrier. (no extra charge)
2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address
side of the article, date, detach and retain the receipt, and mail the article.
3. If you want a return receipt, write the certified -mail number and your name and address on a return
receipt card, Form 3811, and attach it to the front of the article by means of the gummed ends if space
permits. Otherwise, afix to back of article. Endorse front of article RETURN RECEIPT REQUESTED
adjacent to the number.
4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,
endorse RESTRICTED DELIVERY on the front of the article.
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return
receipt is requested, check the applicable blocks in Item 1 of Form 3811.
6. Save this receipt and present it if you make inquiry.
w
IVrO. -,
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED —
NOT FOR INTERNATIONAL MAIL
(See Reverse)
SENT TO
ST(REE AND
' . 1)
P.O., STATE AND ZIP CODE
w
POSTAGE
$
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CERTIFIED FEE
6
W
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SPECIAL DELIVERY
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SHOW TO WHOM AND
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DATE DELIVERED
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TOTAL POSTAGE AND FEES
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POSTMARK OR DATE
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 on the left portion of the address side of
the article, leaving the receipt attached, and present the article at a post office service window or
hand it to your rural carrier. (no extra charge)
2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address
side of the article, date, detach and retain the receipt, and mail the article.
3. If you want a return receipt, write the certified -mail number and your name and address on a return
receipt card, Form 3811, and attach it to the front of the article by means of the gummed ends if space
permits. Otherwise, afix to back of article. Endorse front of article RETURN RECEIPT REQUESTED
adjacent to the number.
4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,
endorse RESTRICTED DELIVERY on the front of the article.
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. It return
receipt is requested, check the applicable blacks in Item 1 of Form 3811.
6. Save this receipt and present it it you make inquiry.
UNITED STATES POSTAL SERVICE
OFFICIAL BUSINESS rTaL�WAR
C 1
SENDER INSTRUCTIONS PP IVATE
Print your name, address, and ZIP Code in the space below. ENT
gSTAO& $300
• Complete items 1, 2, and 3 on the reverse. 1974
• Moisten gummed ends and attach to front of article
if space permits. Otherwise affix to back of article.
• Endorse article "Return Receipt Requested'' adja
cent to number.
RETURN
TO
(. ame of Sender)
n. �a'c �U,
(Street or P.O. Box)
(City, State, and ZIP Code)
0 SENDER: Complete items I. 2, and i.
Add your address in the "RETURN TO'' space on
reverse.
1. Thefollowing service is requested (check one).
Show to whom and date delivered ..........
Show to whom, date, and address of delivery... ¢
RESTRICTED DELIVERY
Show to whom and date delivered .......... ¢
RESTRICTED DELIVERY.
Show to whom, date, and address of delivery. $
(CONSULT POSTMASTER FOR FEES)
2. ARTICLE ADDRESSED TO:
•\\ Or ���� --\, roc
3. ARTICLE DESCRIPTION:
REGISTERED NO. CERTIFIED NO. INSURED NO.
I �iS37&
(Always obtain signature of addressee or agent)
I have received the article described above.
SIGNATURE ❑ Addressee ❑ Authorized agent
a. v
DAT F DELIVERY
POSTMARK
y'
5. ADDRESS (Complete onl&14 usste)
C
6. UNABLE TO DELIVER B AkJ
CLERK'S
INITIAhS
is
�O A
*GPO : 1978-272-932
No. 95 37165
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED —
NOT FOR INTERNATIONAL MAIL
(See Reverse)
SENT TO
STREET AND NO.
P.O., STA E AND ZIP CODE
POSTAGE
$ '
0
W
CERTIFIED FEE
Q
IL
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DELIVERY
Q
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RESTRICTED DELIVERY
Q
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Q
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DATE DELIVERED
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SHOW TO WHOM. DATE,
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AND ADDRESS OF
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DELIVERY
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DELIVERED WITH RESTRICTED
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DELIVERY
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SHOW TO WHOM, DATE AND
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ADDRESS OF DELIVERY WITH
Q
Q
RESTRICTED DELIVERY
TOTAL POSTAGE AND FEES $
POSTMARK OR DATE
STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE, AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES. (see hunt)
1. If you want this receipt postmarked, stick the gummed stub on the left portion of the address side of
the article, leaving the receipt attached, and present the article at a post office service window or
hand it to your rural carrier. (no extra charge)
2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address
side of the article, date, detach and retain the receipt, and mail the article.
3. If you want a return receipt, write the certified -mail number and your name and address on a return
receipt card, Form 3811, and attach it to the front of the article by means of the gummed ends if space
permits. Otherwise, afix to back of article. Endorse front of article RETURN RECEIPT REQUESTED
adjacent to the number.
4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,
endorse RESTRICTED DELIVERY on the front of the article.
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. It return
receipt is requested, check the applicable blocks in Item 1 of Form 3811.
6. Save this receipt and present it if you make inquiry.
UNITED STATES POSTAL -,F-RVJG�
OFFICIAL BUSINESS
ti •.
SENDER INSTRUCTIO PENALTY FOR PRIVATE
U N IOi — USE TO AVOID .PAYMENT
Print your name, address, and ZIP Code in tt Qpace peMw. OF POS Qg,,,130&
• Complete items 1, 2, and 3 on the r v?rse.
• Moisten gummed ends and attach to f nt ofiPile �''• U.S.NUUL
if space permits. Otherwise affix to bae of� t'c i
• Endorse article "Return Receipt RequesTarg"1adfj
cent to number.
RETURN
TO
(Name of Sender)
(Street or P.O. Box)
(City, State, and ZIP Code)
SENDER: Complete items I. ', and ;.
'Add your address in the ''RETURN TO'' space on
reverse.
1. The fo owing service is requested (check one).
ow to whom and date delivered ..........
❑ Show to whom, date, and address of delivery..,_¢
RESTRICTED DELIVERY
Show to whom and date delivered .......... ¢
RESTRICTED DELIVERY.
Show to whom, date, and address of delivery. $
(CONSULT POSTMASTER FOR FEES)
2. ARTICLE ADDRESSED TO:
2aEc?3.
ARTICLE DESCRIPTION:
REGISTEREDNO. CERTIFIED NO. INSURED NO.
9s35) S-I
(Always obtain signature of addressee or agent)
I have received the article described above.
RE ❑ Addressee ❑ Authorized agent
SIGNATWA6SV(donmplete
ERY
POSTMARK
inly if requested)
6. UNABLE TO DELIVER BECAUSE:
CLERK'S
INITIALS
*GPO : 1978-272-932