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Postal <br /> CERTIFIED oRECEIPT <br /> Domestic Mail Only <br /> E' <br /> O <br /> LnCertified Mail Fee <br /> Extra Services&Fees(check box,add fee as appropnate) w`w n ce <br /> CD ❑Return Receipt(hardcopy) $ \ • \v" <br /> E]Return Receipt(electronic) $ P <br /> � E] Here Cerlifed Mail Restricted Delivery $ Here <br /> [:]Adult Signature Required $ <br /> []Adult1�1.�a' 2n <br /> Adult Signature Restricted Delivery$ <br /> O Postage Ln ., O 60 2/L/ <br /> M $ TONY VERDI O Total Postage an <br /> $ RE: BLUE SHIELD OF CALIFORNIA <br /> � <br /> Sent To 3021 REYNOLDS RANCH PKWY <br /> 0 Street an dAm WE LODI, CA 95240 <br /> City,State,2IP+4 Re: PR0535625 Rtn: RL <br /> COMPLETE SECTIONCOMPLETE THIS SECTIONON DELIVERY <br /> ■ Complete items 1,2,and 3. A. Signature <br /> ■ Print yo� firlaf <br /> ddre reverse X ❑Agent <br /> so that t� e �° u. , \ El Addressee <br /> ■ Attach this card to the bac oailpiece, B. Received by(Printed Name) C. Date of Delivery <br /> or on the front if space permits. q 1-k7 <br /> 1. Article Addressed to: D. Is delivery address different from item 1? U Yes <br /> TONY VERDI If YES,enter delivery address below: ❑ No <br /> RE: BLUE SHIELD OF CALIFORNIA <br /> 3021 REYNOLDS RANCH PKWY SEP 0 8 2 22 <br /> LODI, CA 95240 <br /> Re: PR0535625 Rtn: RL II�F'>LTH <br /> II I III II II II II I III III II I II II II IIII I I I I 3. Service Type ❑RegPriority Mail Express® <br /> I ❑Adult Signature ❑Registered MaiIT'^ <br /> ❑Adult signature Restricted Delivery 0 Registered Mall Restricted <br /> XT Certified Mail® Delivery <br /> 9590 9402 6099 0125 5594 56 0 Certified Mail Restricted Delivery ❑Return Receipt for <br /> ❑collect on Delivery Merchandise <br /> ❑Collect on Delivery Restricted Delivery D signature Confirmation- <br /> 2. Article Number(transfer from service label) —. Mail ❑Signature Confirmation <br /> o,il Restricted Delivery Restricted Delivery <br /> 7021 0350 0000 815 0 1964 <br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt <br />