\
RECEIVED
CLERK'S OFFICE
DEC 2 6 2007
STATE OF ILLINOIS
Pollutfo
r
, Control Board
SENDER:
COMPLETE THIS SECTION
COMPLETE THIS
SECTION
ON DELIVERY
■ 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 mailplece,
or on the front If space permits.
1. Article Addressed to:
12/20/07 B.
AC 2008-008
James and Mildred Taviner
1004 Fowler Road
P.O. Box 498
Hardin, IL 62047-0498
A. Signature
q
Agent
q
Addressee
C? ry
a
of
B. Received by
(Printed Name)
e of/Delive
lot
D. Is delivery address different from item 1?
q
Yes
If YES, enter delivery address below:
?
q
No
Ice Type
teed Mall
q
Express Mall
Registered
?
q
Retum Receipt for Merchandise
q
Insured Mail
?
q
C.O.D.
4. Restricted Delivery?
(Extra Fee)
?
q
Yes
x
ef4 -/"A vi ne.g
2. Article Number
(Transfer from service label)
7006 0810 0004 2225 2201
PS Form 3811, February 2004
Domestic Return Receipt
102595-02-M-1540 !,