SENDER:

COMPLETE THIS SECTION

COMPLETE THIS SECTION ON

DELIVERY

•

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

maiipiece,

or on the front if space permits.

1.

Article Addressed to:

5

/

19/05

B

•

M.

AS

2005—006

Debra

J.

Meadows

-

Goldenberg,

Miller,

Heller

Antognoli,

P.C.

2227

South

State

Route

157

P.O.

~ox

995

Edwardsville,

IL

62025

R~C~V~D

CLERK’S OFFICE

~4AY

272005

STATE OF ILL1NO~S

PollutLon ContrO’ Board

A

Signature

x

~

cLL_-’~

~ssee

B.

Received ~y

(Pdntedf~anf~)

C.

Date of Delivery

Is

deliveryaddress

different

fror~f

tt~m

1?

0

Yes

If

YES,•~nter

deliv~~ddress,~e~w:

0

No

~

/.~j

3.

,~SeMce

Iype

~~Qerttfied

Mail

0

Express

Mall

P

Registered

D~etum

Receipt for Merthandise

0

Insured Mall

0

C.O.D.

4.

RestrIcted Delivery?

(Extra

Fee)

0

Yes

2.

ArtIcle Number

PS

(Tmnsferfromseivlce/abel)

7004

Form

3811,

February 2004

2890

0004

Domestic Return

2307

0929

Receipt

1O2595~O2.ML154O