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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete na re <br /> item 4 if Restricted a is desi . ❑Agent <br /> ■ Print you re t reverse Addressee <br /> so that e c u. Regeived by(P ted Named C. D Qf�I <br /> ■ Attach th ac ailpiece, 1 9ef <br /> or on the front if space permits. <br /> D. Is delivery address different from item 1? 13 es <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑No <br /> SJ GENERAL HOSPITAL* <br /> 500 W HOSPITAL RD <br /> FRENCH CAMP CA 95231 <br /> 3. Service Type <br /> Certified Mail ❑Express Mail <br /> ❑Registered ❑Return Receipt for Merchandise <br /> ❑Insured Mail ❑C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7004 2510 0003 3789 1822 <br /> (Transfer from service label) <br /> PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 J <br />