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COMPLETE . COMPLETE <br /> ■ Complete items 1,2,and 3.Also complete A. Sj � <br /> item 4 if Restricted Delivery is desired. \� ❑ ent <br /> ■ Print your name and address on the reverse X ddre ee <br /> so that we can return the card to you. B eceiv 'byto r�l� C.p <br /> ■ Attach this card to the back of the mailpiece, a <br /> or on the front if space permits. I a-4 <br /> Is delivery address different from item V ❑Y <br /> 1. Article Addressed to: If YES,enter dellyrerv�C;MVfI <br /> RICHARD J KOOISTRA JAN 31 2011 <br /> 1523 W RUTLEDGE WAY <br /> STOCKTON CA 95207 3. Service Type <br /> ft Certified Mail ENVIRP TALHEAL7�-� <br /> 30 DAY OR DA LTR ❑ Registered 1�P w" or 11171erc andise <br /> RE 1523 W RUTLEDGE WAY, STKN ❑ Insured Mail ❑C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7010 2780 0000 6640 1789 <br /> (Transfer from service label) <br /> PS Form 3811,February 2004 Domestic Return Receipt 102595.02-M-1540 <br />