Sample - Continuous Absence - Exhaustion Of Paid Leave - No Communication Page 4

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[OPTIONAL LANGUAGE ‐ If mailed via U. S. Postal Service, the following certification may be typed at 
the bottom of the letter.] 
 
The  undersigned  certifies  that  the  above  letter  /  notification  was  mailed  to  [name]  by  first‐class  and 
certified mail, return receipt requested, on the __________day of ____________, 20_____. 
 
[signature]_____________ 
[typed name and title] 
 
[NOTE:  Revised 6/2013.  Ensure law, rule, and policy language is current.] 

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