Postmaster Date: 8/5/02
City, State, ZIP Code
REQUEST FOR CHANGE OF ADDRESS OR BOXHOLDER INFORMATION NEEDED FOR SERVICE OF LEGAL PROCESS
Please furnish the new address or the name and street address (if a boxholder) for the following:
Name: Opt In Freebies, Inc.______________________________________________________
Address: PO Box 5038___________________________________________________________
Note: The name and last known address are required for change of address information. The name, if known, and post office box address are required for boxholder information. The following information is provided in accordance with 39 CFR 265.6(d)(4)(ii). There is no fee for providing boxholder information. The fee for providing change of address information is waived in accordance with 39 CFR 265.6(d)(1) and corresponding Administrative Support Manual 352.44a.
1. Capacity of requester (e.g., process server,
attorney, party representing self): Representing
Self
2. Statute or regulation that empowers me to serve process (not required when requester is an attorney or a party acting pro se—except a corporation acting pro se must cite statute: CALIFORNIA BUSINESS AND PROFESSIONS CODE SECTION 17538.4
3. The names of all known parties to the
litigation: Opt In Freebies, Inc.
4. The court in which the case has been or will
be heard: California Small Claims
Court
5. The docket or other identifying number if
one has been issued: Not yet issued
6. The capacity in which this individual is to
be served (e.g., defendant or witness): Defendant
______________________________________________________________________________
WARNING
THE SUBMISSION OF FALSE INFORMATION EITHER (1) TO OBTAIN AND USE CHANGE
OF ADDRESS INFORMATION OR BOXHOLDER INFORMATION FOR ANY PURPOSE OTHER THAN THE
SERVICE OF LEGAL PROCESS IN CONNECTION WITH ACTUAL OR PROSPECTIVE LITIGATION OR
(2) TO AVOID PAYMENT OF THE FEE FOR CHANGE OF ADDRESS INFORMATION COULD RESULT
IN CRIMINAL PENALTIES INCLUDING A FINE OF UP TO $10,000 OR IMPRISONMENT OF NOT
MORE THAN 5 YEARS, OR BOTH (TITLE 18 U.S.C. SECTION 1001).
I certify that the above information is true and that the address information is needed and will be used solely for service of legal process in conjunction with actual or prospective litigation.
_________________________________________ (Address Omitted)________________
Signature Address
(Name Omitted)___________________________ (Address Omitted)________________
Printed Name City, State, ZIP Code
______________________________________________________________________________
FOR
POST OFFICE USE ONLY
__________ No change of address order on file. POSTMARK
__________ Moved, left no forwarding address.
__________ No such address.
NEW ADDRESS OR BOXHOLDER’S NAME AND STREET ADDRESS
_________________________________________________________
_________________________________________________________
_________________________________________________________