RECEIVED

CLERK’S OFFICE

JAN 312005

STATE OF ILLINOIS

Pollution Control Board

B. eceived by

(Pdnted

Name)

~ Dat/~fDe~e~

/fL7/o~

o. ~4~hveryaddress different from item 1?

YeS

YES, enter delivery address below:

El

No

3. Service Type

El

Certified Mail

0 Express Mail

o Registered

0 Return Receipt for Merchandise

o Insured Mail

0 COD.

SENDER

COMPLETE THIS SECTION

• Complete items 1, 2, and 3. Also complete

item 4 if Restricted Delivery is desired.

a 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.

ArticleAddressedto:

1/20/05 B.M.

AC 2005—005

Gerald L. Timmerwilke

Blickhan, Woodworth &

Timmerwilke

435 Hampshire Street

Quincy, IL 62301

4. Restricted Delivery?

(Extra

Fee)

0 Yes

2. Article Number

(Transferfrom service

Iab&)

PS Form 3811, February 2004

Domestic.Return Receipt

102595-02-M-1540