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Z 016 974 240 <br /> eipPgJr2 <br /> Certified Mail <br /> No Insurance Coverage Provided <br /> Do not use for International Mail <br /> MAXINE AND JOHN GEMELOS <br /> 456 E HOLLYWOOD <br /> TRACY CA 95376 <br /> wwya $ {� <br /> Certified Fee <br /> Z. <br /> Special Delivery Fee <br /> Restricted Delivery Fee <br /> Return Receipt Showing <br /> W to Whom&Date Delivered <br /> r <br /> t Return Receipt Showing to Whom, <br /> Date,and Addressee's Address <br /> TOTAL Postage <br /> O &Fees • <br /> r� <br /> QPostmark or Date <br /> 0 <br /> m _ <br /> !! I also wish to receive the <br /> y • o I m or r atldi servic s <br /> m • m ete i s 3,and 4a&b- g ser ( r ("d '•V <br /> 2 • Print your name and address on the reve of his form so that we can � � <br /> areturn this card to you. <br /> y • Attach this form to the front of the mailpiece,or on the back if space 3. ❑ Addressee's Address y <br /> i does not permit. <br /> t • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery <br /> • The Return Receipt will show to whom the article was delivered and the date Cm7 <br /> c delivered. Consult postmaster for fee. <br /> m 3. Article Addressed to: 4a. Article Number <br /> - - •�� 0 <br /> CL MAXINE AND JOHN GEMELOS 4b. Service Type m <br /> 0 456 E HOLLYWOOD ❑ Registered ❑ Insured °C <br /> U to <br /> TRACY CA 95376 Certified ❑ COD c <br /> W Express Mail ❑ Return Receipt for <br /> Merchandise o <br /> C 7. Date gf De v7ery 0 <br /> / C 1 0 <br /> 5. Si nature (Addressee) 8. Addres e s ddress(Only if requested <br /> { and f is id) ra <br /> t t <br /> �} 6. Ignature (Ag ) ~ <br /> n, <br /> PS Form 3 1 1, December 1991 *U.S.GPO:1993-952-7ta D ESTIC RETURN RECEIPT <br />