ORIGINAL..
    SENDER:
    COMPLETE THIS SECTION
    •
    Complete items
    1, 2, and 3. Also complete
    item 4
    if Restricted
    Delivery is desired.
    •
    Print your name and
    address on the
    reverse
    so that we can return the card to you.
    •
    Attach this card to the back of the mailpiece,
    or on the front if space permits.
    1.
    Article Addressed to:
    6/
    16
    /
    05
    B
    .
    M.
    PCB
    2005—210
    Jeff
    Borgic
    4204
    N.~l600th
    Street
    Newton, IL 62448
    RECEIVED
    CLERK’S OFFICE
    JUN 29
    2005
    STATE OF ILLINOIS
    PoIIut~on
    Control Board
    COMPLETE THIS SECTION ON DELIVERY
    A.
    Signature
    o
    Agent
    o
    Addressee
    C.
    Date of Delivery
    o
    Express Mail
    o
    Return Receipt for Merchandise
    o
    C.O.D.
    4.
    Restricted
    Delivery?
    (Extra Fee)
    0
    Yes
    2.
    Article Number
    (rransfer
    from
    service label)
    PS Form
    3811,
    February 2004
    7004
    2890 0004 2307
    1216
    x
    D.
    Is delivery address different horn
    item 1?
    0
    Yes
    If YES, enter delivery address below;
    0
    No
    3.
    Service Type
    ~Certif
    led Mail
    o
    Registered
    o
    Insured
    Mail
    Domestic Return
    Receipt
    102595-02-M-1540

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