REcE~vED
    CLE~’~OFFfCE
    JUN29
    2005
    0 R
    I G
    I
    NA L
    STATE OF ILLINOLS
    Poltutj~n
    Control Boarc~
    SENDER:
    COMPLETE THIS SECTION
    COMPLETE THiS SECTION ON DELIVERY
    R
    Complete
    items
    1, 2,
    and 3. Also complete
    A.
    Signature
    .lAgent
    item
    4 if Restricted
    Delivery is
    desired.
    x
    a
    Print your name and address on the reverse
    _____________________________________________
    so that we can
    return the card to you.
    B~~ceived
    by
    (Printed N
    e)
    a
    Attach this card to the back of the
    mailpiece,
    7pN~p
    C:.
    or on the front if space permits.
    D.
    Is
    delivery address different from
    item 1?
    0
    Yes
    If YES,
    enter delivery
    address
    below:
    0
    No
    1.
    ArticleAddressed to:
    6
    / 16/
    05
    ~
    N.
    PCB
    2005—211
    Richard
    Ver
    Heecke
    8417 US Highway
    6
    Geneseo,
    IL 61254
    3.
    S~vice
    Type
    ertified Mall
    0
    Express Mail
    O
    Registered
    0
    Return
    Receipt for Merchandise
    o
    Insured Mail
    0
    C.O.D.
    4.
    Restricted
    Delivery?
    (Exfra
    Fee)
    0 Yes
    2.
    Article Number
    (Transfer
    from
    sen,ice label)
    7Q04
    2.891)
    0004
    2307
    1223
    ~
    PS Form
    3811.,
    February 2Ob4~”
    ~&nesticReturn
    Receipt
    1o2595-02-M-154o

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