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c- <br /> .Complete Rains t and/or 2 for addWorel services. I also wish W reoeive ft <br /> •compote tone 3,4a,and 4b. folowkV services(for an <br /> a Prkrt your nerve and address on the reverse of V*term so that we can rem this extra fee): <br /> 2 t6 torte to the front of the walpiace,or on the bom*d space does not <br /> 1. ❑ Addressee's Address <br /> penvdL <br /> a Wdle'Rown Recap Requested'on the mailpieoe below the arttds f%1n*K 2.❑ Restricted Delivery <br /> ■The Return Recslpt wit show to wtmm the aAlde was ddvwod and the date <br /> delivered. Consult postmaster for fee. <br /> 3.ArWe Addressed to: <br /> ?001 2 510 0 0 16 7 5 <br /> CIWMB 3 <br /> ATTN KEITH KENNEDY MS#15 0 Regi a; CertlBed <br /> 1001 I ST p p Insured ,riO1 <br /> o. <br /> PO BOX 4025 ~` ❑ COD .a <br /> SACRAMENTO CA 95814- -. <br /> 5.Received By:(Print Name) Litu 8. 's AddrkW(Ohlyff requested <br /> B.Signafu EIVIVIRUNK ENT HE..ALT ) DEC 1 2 2002 <br /> x PERMIT SERVICES T HEALTH <br /> a PS Form 3811994 102595-97-M179 t <br /> BBINS <br />