104 LAFAYETTE STREET UNIT 23 RETURNED CERTIFIED MAIL CARD 12-23-2025 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
* Complete items 1,2,and 3. A. Signa
-* Print your name and address on the reverse X �4 ^ ❑Agent
so that we can return the card to you. ❑Addressee
I4r1 Attach this card to the back of the mailpiece, B. Re ive�fiy(Printed Name) C. Date of Delivery
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes
Nor1 � �.p C If YES,enter delivery address below: ❑No
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3. Service Type ❑Priority Mail Express®
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I Il IN 1111111111111111111 ❑Adult Signature El Registered Mail
I ❑ RAdult Signature Restricted Delivery ❑Registered Mail Restricted
(Certified Mail@ Delivery
9590 9402 9526 5069 4843 76 ElCertified Mail Restricted Delivery ❑Signature ConfirmationTM
❑Collect on Delivery ❑Signature Confirmation
2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery Restricted Delivery
❑Insured Mail
9589 0 710 5270 3103 1106 80 v,11 Restricted Delivery
PS Form 3811,July 2020 PSN I 530-02-000-ND3 Domestic Return Receipt
USPS TRACKNIG# —
First-Class Mail
Postage&Fees Paid
USPS
Permit No.G-10
9590 "0295265069 4843 76
United States •Sender:Please print your name,address,and ZIP+4®in this box•
Postal Service
R EC E I E D -� CITY OF SALEM
BOARD OF HEALTH
DEC 2 3 25 98 WASHINGTON ST,3TD FL
SALEM,MA 01970
CITY OF SA EM
BOARD OF H