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To:
Department of Rehabilitation
Attn: Director's Office, Comments/Complaints
721 Capitol Mall
Sacramento, CA 95814
Subject: ______________________________________________________________________________
Comment/Complaint: _____________________________________________________________________
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To better assist in the resolution of any situations with the Department,
please fill out the optional items below.
Note: This data is optional. If you wish to remain anonymous,
do not complete this section.
Name________________________________________________________________________________
Mailing Address________________________________________________________________________
City, State, ZIP Code____________________________________________________________________
Phone Number_________________________________________________________________________
Social Security Number__________________________________________________________________