ORIGINAL

.

RECEIVEDCLERK'S

OFFICE

AUG 2 1 2006

Pollution

STATE OF

control

ILLINOISBoard

SENDER

:

COMPLETE THIS SECTION

1

COMPLETE THIS SECTION ON DELIVERY

B . Receivedby

(Printed

I,111'

Name)

.

./

0

o

AgentAddressee

te~f l

A Signs um

4 . Restricted Delivery? (Extra

Fee)

0 Yes

0 No

0 Yes

∎ 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 mailpiece,

or on the front if space permits

.

Article Addre sedto

8/4/06 B .M .

PCB 2005-215

PaTri~~ha

Gibbs

First Rockford

Group

6801

Spring Creek

Road

Rockford,

IL 61114

2

. Article Number

j

(Transferfrom sen4eIabeQ

7005 1160

0002 2068 0015

PS Form

3811, February

2004

Domestic Return Receipt

I ∎

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

.

I

∎ Attach this card to the back of the mailpieceI

or on the front If space permits

.

.

Article Addressed to :

8/4/06 B .M

.

PCB 2005-215

Sumil Puri

First Rockford Group

6801 Spring Creek Road

Rockford, IL 61114

2 Article Number

(Ransferfromservlcelabel

7005 1160 0002 2068 0008

PS Form 3811,

February 2004

Domestic Return Receipt

D

. Is delivery address different from item ?

If YES, enter delivery address below

:

3 . Service Type

0 Certified Mall

0 Express Mall

0 Registered

0 Return Receipt for Merchandise

0 Insured Mall

0 C.O.D .

102595-02-M-1540

COMPLETE THIS SECTION ON DELIVERY

111111111

.

S

. Received

by (Printed Name)

I

p

. Is delivery address different from item 1?

es

If YES, enter delivery address below

:

0 No

SENDER :

COMPLETE THIS SECTION

. Signature

X

0 Agent

0 Addressee

C Date of Delivery

4

. Restricted Delivery? (Extra Fee)

0 Yes

3. Servlcelype

-t,(Cettified

0_

RegisteredMall

0

Express Mail

0

Return Receipt for Merchandise

0

Insured Mall

0

C.O.D .

102595-02-M-1540