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DISABILITY INSURANCE

PO BOX 201006
STOCKTON, CA 95201-9006 (800) 480-3287
UNITED STATES

SUNSHINE GALLEGOS
1514 ARCADE BLVD
SACRAMENTO, CA 95815-1402
UNITED STATES

NOTICE OF OVERPAYMENT OFFSET

SSA NO. 527-47-5879 MAILING DATE 10/02/17

$90.36 has been withheld from your benefits and credited to your Overpayment(s).

State of California / Employment Development Department

DE 826 Rev. 1 (2-91)