ORIGINAL

RECEIVEDCLERK’S

OFFICE

AUG

312005

STATE OF

PoHutjon Control

Board

SENDER:

COMPLETE THIS SECTION

a

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.

I. AsticleAddressedto:

8/18/05 B.M.

PCB 2006—022

Julia Walters—Edwards

P.O. Box 146

Farrnington, IL 61531

2. Article Number

(Transfer from

serv/ce

label)

/

8.

c_~

0.

Received by

(Pi*~tedName)

/1G.

Date of Delivery

0 ravn4p I

Is delivery address different from item

0 Yes

If YES, enter delivery address below:

0 No

3. Service Type

o

Certified Mail

0 Express Mail

C Registered

D Return Receipt for Merchandise

o

Insured Mail

0 COD.

4. Restricted Delivety?

(Extra Fee)

0 Yes

).Ai~~ture

w

C Addressee

7004 2890 0004 2307 1629

PS Form 3811, February 2004

Domestic Return Receipt