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MAIL ADDRESS (Optional): ATTORNEY FOR (Name): IN PRO PER SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO 720 NINTH STREET 720 NINTH STREET CITY AND ZIP CODE: SACRAMENTO, CA 95814 BRANCH NAME: CIVIL PETITIONER/PLAINTIFF: NAME OF PLAINTIFF ON COMPLAINT RESPONDENT/DEFENDANT: NAME OF DEFENDANT ON COMPLAINT STREET ADDRESS: MAILING ADDRESS: PROOF OF SERVICE BY FIRST-CLASS MAIL CIVIL CASE NUMBER: 34-2010-00011111 1. (Do not use this Proof of Service to show service of a Summons and Compl.

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