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• <br /> Postal <br /> CERTIFIED o RECEIPT <br /> ra Domestic Mail Only <br /> rU <br /> ro Certified Mail Fee <br /> 117 <br /> 17- $ <br /> M Extra Services&Fees(check box,add fee as appropriate) <br /> ❑Return Receipt(hardcopy) $ <br /> O ❑Return Receipt(electronic) $ Postmark <br /> 1--3 ❑Certified Mail Restricted Delivery $ Here <br /> EO E]Adult Signature Required $ <br /> O ❑Adult Signature Restricted Delivery$ <br /> 13 Postage <br /> r-q $ <br /> 1:0 - <br /> ra <br /> o ANDRES AND OLGA GOMEZ <br /> "' 179 BISMARK ST <br /> 0 <br /> r` DALY CITY CA 94014 ---------------- <br /> SECTIONCOMPLETE THIS ON DELIVERY <br /> COMPLETE • <br /> ■ Complete items 1,2,and 3. A. Signature <br /> ❑Agent <br /> ■ Print your n and address on the reverse X ❑Addressee <br /> so that we nYou. '` <br /> ■ Attach thisft�lt�the a k e mailpiece, <br /> or on the front if space permits. <br /> B. Received by(Printed Name) ]VC, Date of Deli <br /> I <br /> 1. Article Addressed to- D. Is delivery address different from item 1? ❑Yes <br /> If YES,enter delivery address below: ❑ No <br /> ANDRES AND OLGA GOMEZ <br /> 179 BISMARK ST <br /> DALY CITY CA 94014 , t <br /> II I I I I I I I I II III 3. Service Type El Priority Mail Express® <br /> ❑Adult <br /> Signature ❑Registered Mall— <br /> Adult Signature Restricted Delivery ❑Registered Mail Restricted <br /> 111111110 1111111111111111111111 <br /> II I IIIIIIII II I II I ii <br /> Certifed Mails Delivery <br /> 9590 9402 6099 0125 5509 10 ❑Certified Mail Restricted Delivery F]R eurn Re seipt for <br /> ❑Collect on Delivery ❑Signature Confirmation- <br /> 2. <br /> Collect on Delivery Restricted Delivery g <br /> 2. Article Number(Transfer from service label) nail ❑Signature Confirmation <br /> 7020 1810 0 0 0 0 3 9 9 8 7 2 41 a)il Restricted Delivery Restricted Delivery <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 <br /> Domestic Return Re ' t <br />