CL~iR~S

OFF1~~

NOV

2 ~

2004

STATE OF

ILUNO~S

Pollution Control Board

SENDER~

COMPLETE THIS SECTION

I

Complete items

1,

2, and 3. Also complete

item

4 if Restricted Delivery is desit~d~

•

Print yOur name and address on the reverse

so that we can return the card to you.

I

Attach this card to the back ofthe mailpiecé,

•or on the front

if space permits.

1.

Article Addressed to:

1 1

/

18

/

04

B

.

M.

PCB 2005—081

Kathryn and Brian Bradley

RR

#1,

Box

69

Timewell,

IL 62375

“c~e~ei~d

by

(7(nt’ed Name)

~4C.

D1te73~

D.

Is

delivery address different frsm item

1?

D’Yes

If YES, enter delivery

address below:

0

No

3.

SetviceType

ertifled

Mail

0.

Express Mail

.

Registered

0. Return Receipt for Merchandise

0

Insured Mail.

.

D.co.p.

:

..~

.

.

4.

Restricted DeIi~è~:~*Fe~

0

Yes.

102595-02-M-1540

2.

Article

Number

(Transfer

from sèMceJabel)

7004 0750

0004

3960

1833

PS Form

~381

1,

February 2004

bor~estic

RetUrn Reóeipt

A.

Signature

x

0

Agent

~

0

Addressee