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6 0 <br /> Postal <br /> CERTIFIED MAIL,,., RECEIPT <br /> frt , <br /> Provided)— <br /> r-m <br /> - 11111111MINS <br /> N <br /> M <br /> Postage $ <br /> Certified Fee <br /> O Postmark <br /> O Return Receipt Fee Here <br /> O (Endorsement Required) <br /> C3 Restricted Delivery Fee <br /> Q (Endorsement Required) ' <br /> �O - <br /> lti <br /> N <br /> C3 RAFAEL GOMEZ <br /> � 500 N JACK TONE RD - "' ' ' <br /> N STOCKTON CA 95215 .................. <br /> SECTIONCOMPLETE THIS DELIVERY <br /> SENDER: COMPLETE THIS SECTION <br /> ■ Complete items 1,2,and 3.Also complete A. Sign ure � 'Agent <br /> item 4 if Restricted Delive i esired. X ❑Addressee <br /> ■ Print your n � r�the reverse <br /> so that we �e C you. B. eceiv y Printed Date of Delivery <br /> %la■ Attach this card to the back of the mailpiece, ( e <br /> or on the front if space permits. — <br /> D. Is delivery address <br /> 1. Article Addressed to: If YES,enter deliv %D <br /> OCT 03 2011 <br /> RAFAEL GOMEZ 11 <br /> 500 N JACK TONE RD <br /> STOCKTON CA 95215 s. service Type ,PERVICES <br /> Certified Mail 13 I� <br /> Registered ❑Return Receipt for Merchandise <br /> ❑Insured Mail ❑C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7010 2?80 0000 6637 4373 <br /> (Transfer from service label) — <br /> 102595-02-M-1540 <br /> PS Form 3811,February 2004 Domestic Return Receipt <br />