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COMPLETE• A. Signature ❑Agent <br /> ■ Complete items 1,2,and 3.Also complete X �""❑Addressee <br /> item 4 if Resr saIirse /�� <br /> ■ Print your nai a C. ate o Delivery <br /> so that we ca B. Receive by(Printed Name) , <br /> ■ Attach this card to the back of the mailplece, 1C C <br /> or on the front if space permits. D. Is delivery address different from item 12 Y <br /> 1. Article Addressed to: If YES,enter delivery address bel)w: <br /> ❑No <br /> USA GASOLINE #3696* <br /> 2448 W KETTLEMAN LN <br /> LODI CA 95240 3. Service Type <br /> YJ Certified Mail 0 Express Mail <br /> 0 Registered 0 Return Receipt for Merchandise <br /> 0 Insured Mail 0 C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) 0 Yes <br /> 2. Article Number 7004 2310 0003 3789 1273 <br /> (transfer from service label) Domestic Return Receipt 102595-02-M-1540 <br /> PS Form 3811, February 2004 <br /> Postal <br /> m CERTIFIED MAIL,. RECEIPT <br /> rj (Domestic Mail Only; . Insurance CoverageProvided) <br /> For delivery information visit our website at a <br /> U� . <br /> �d <br /> f`- <br /> SE I <br /> m Postage $ <br /> M Certified Fee <br /> O <br /> Postmark <br /> Return Receipt Fee Here <br /> (Endorsement Required) <br /> 0 Restricted Delivery Fee <br /> rq (Endorsement Required) <br /> r'U Total Postage! <br /> � USA GASOLINE #3696* <br /> o Sent To 2448 W KETTLEMAN LN <br /> 0 <br /> rrr'aer,Apcivo.i' LODI CA 95240 <br /> or PO Box No. <br /> City,State,ZIP+ <br /> :ri ri <br />