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

to you .

•

Attach this card to the be the mailpiece,

or on the front if space pe

is 4

C . Dat of Deli

S a9

7

B.M .

37

&

A

. Signature

X

Received by (Printed

Name)

Ag

0 Add

Is delivery address different from Item 17

0 Y

If YES, enter delivery address below:

1

. Article Addressed to :

0

No

5/1

ACC2007-036, AC 200

AC 2007-038

Lawrence A

. Bartolom

` P .O . Box 2325

Mt

. Vernon, IL 62864

I

2 . Article Number

(Transfer from semicelabel) 7006

2760 0003 5423

6713

PS Form 3811,

February 2004

Domestic Return Receipt

COMPLETE THIS SECTION ON DELIVERY

B .

ce Type

Mail 0

Express Mail

Registered

0 Return Receipt for Merchandise

0 Insured

Mail

0 C.O .D.

4 . Restricted Delivery?

(Extra Fee)

0 Yes

y-

102595-02-M-1540

RECEIVEDCLERK'S

OFFICE

JUN 0 4 2007

Pollution

STATE OF

Control

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