CLERK’S

~c~

OFFICE

/~J

142005

POIIUtlOflSIA1EOF,LL~IOIS

ControlBoard

SENDER:

COMPLETE TI-uS SECTION

COMPLETE THIS SECTION ON DELIVERY

$ Complete item~1, 2, and 3. Also complete

A. Signature

item 4 if Restricted Delivery is desired.

0 Agent

i Printyourname and address on the reverse

Addressee’

so that we can return the card to you.

B. ~eceived

by/Printed

Name)

C. Date of Delivery

• Attach this card to the back of the mailpiece,

e’~

3—1 ~ a~c~

- or on the front if space permits.

D. Is delivery address differen~fromitem 1? 0 Yes

1. Article Addressed to~ 3 / 3 /05 B M.

If YES, enter delivery address

below:

0 No

PCB 2004—094

I~enneth Hauck

Rock River Estates Mobile

Home Park

291 Illinois Route 2          

~~ertifledMail

0 ExpreasMail

Dixon, IL 61021          

1J Registered

Return Receipt for~Merchandise

Insured Mail

0. C~O.D.

4~Restricted Delivery? (Extre Fee)

Dyes

2. Article Number

(rransférfrom service

label)

7004 2890 0004 2296 1006

PS Form 3811 , Febtuaty

2004

Dome~icFt~turnReceipt

102595-02-M-1540