RECEIVED
    CLERK’S
    OFFICE
    NOV
    012004
    STATE OF ILLINOIS
    PoUut~onControl Board
    SENDER:
    COMPLETE THIS SECTION
    •
    Complete items 1, 2,
    and 3. Also complete
    item
    4 if Restricted Delivery is desired.
    •
    Print yoUrname and address on the reverse
    so that we can return the card to you.
    •
    Attach thiscard to the back of the mailpiece,
    or
    on
    the front if space permits.
    1.
    Article Addressed
    to:
    10/7
    /
    04
    B
    M.
    AC
    2005—016
    Richard
    Groff
    I
    23493
    Sebree
    Road
    Canton,
    IL
    61520
    2.
    Art~c!e
    Number
    (Transferfro,n service label)
    o
    Expr~s
    Mail
    DReturn Receipt fOr Merchandise
    o
    C.O.D.
    4.
    Restricted Delivery?
    (Extra
    Fee)
    0
    Yes
    7002
    0860
    0004
    9617
    9953
    3.
    S~Mce
    Type
    ~~.Pertified
    Mail
    O
    Registered
    o
    InsUred Mail
    PS Form
    3811,
    February 2004
    Domestic Return
    Receipt
    102595-02-M-I540

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