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� r <br /> l <br /> COMPLETE •N COMPLETE THIS SECTIONON DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. X ❑Agent <br /> ■ Print your name and address on the reverse ❑Addressee <br /> so that we can return the card to you. B. Received by(Printed Name) T <br /> Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits <br /> D. Is delivery address different from item 1? ❑Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑ No <br /> RICHARD KOOISTRA <br /> 1523 W RUTLEDGE WAY <br /> STOCKTON CA 95207 3. Service Type <br /> 0 Certified Mail ❑ Express Mail <br /> IP/PKTJPL/OIR ❑ Registered ❑ Return Receipt for Merchandise <br /> RE 1523 W RUTLEDGE WAY, STKN ❑ Insured Mail ❑ C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7006 3450 0003 7438 6439 <br /> (Transfer from service label) <br /> PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 <br />