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SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signat re <br /> item.4 if Restricted Delive is desired. ❑Agent <br /> ■ Print your n the reverse �* �✓ ❑Addressee <br /> so that we�t�t�c you. B. Rec ive by Printed Name) C. Date f Delive <br /> ■ Attach this card to the back of the mailpiece, fj3 <br /> or on the front if space permits. <br /> D. Is delivery address different from item 19 ❑Yes <br /> 1. Article Addressed to: 0)0CLftV(EzDlow: 13 No <br /> RAFAEL GOMEZ AUG 2 4 2011 <br /> 500 N JACK TONE RD <br /> STOCKTON CA 95215 TA EALT <br /> R eress%ail <br /> VO— e eyed L I Return Receipt for Merchandise <br /> ❑ Insured Mail ❑C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7010 2780 0000 6637 4922 <br /> (transfer from service label) <br /> PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 <br />