ORIGINAL

SENDER :

COMPLETE THIS SECTION

I

∎ Complete items 1, 2, and 3

. Also complete

1

item 4 if Restricted Delivery is desired

.

I ∎ Print your name and address on the reverse

li

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

.

11 . Article Addressed to :

2/15/07

PCB

2005-049

Morton F . Dorothy

104 W .

University

SW Suite

Urbana, IL 61801

jt

COMPLETE THIS

SECTION ON DELIVERY

B . Received

K

b

1

(Printed

.2Yw

Name)

"

I

2 . Article Number

(Dansferfrom service label)

7002 0860 0004 9604

PS Form 3811, February 2004

Domestic Return Receipt

D

. Is delivery address di rent from tern 7 0 Yes

If YES, enter delivery address below :

jNo

3. Service Type

0

Certifi

0R

0

4. Res ad

1 0 Express Mail

0 Return Receipt for Merchandlsl

D C .O.D .

In Fee)

D Yes

RECEIVEDCLERK'S

OFFICE

APR 0 9 2007

Pollution

STATE OF

Control

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