\~L~
~
SENDER:
COMPLETE THiS SECTION
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 cart r~tuXn
the card to you.
•
Attach this card to the back of the mailpiece,.
c~r
on the front if space permits.
1.
ArticleAddressedto~
2/17/05
PCB
2005—151
John and Ann Beckman
10951 N.
1950th St.
B
.
M,7
RECEIVED
CLERK’S OFFICE
MAR
-32005
STATE OF ILLINOIS
Pollution Control Board
A.
Signet
~
0
Addressee
~ecelved
by
(Printed
Name)
.
C.
Da
of
elivery
I).
Is
delivery
address
different
from item 1?
0
Yes
If YES, enter delivery address below:.
0
No
Dieterich,
IL
62424
.3.
S~Mce
Type
~ertlf
led Mail
0
Express
Mail
,D
Register~d.
0
Return Receipt for Merchandise
0
Insured
MalI
0
C.O.D.
4.
Restricted Delivery?
(Extra
Fee)
D~Yes
2.
Article
Number
(rransferfrornserilce/abel)
7004 2890 0004 2296 0917
PS: Form 381
1,
February
2004..
..
DomeCtic Return Recelpt.~
102595-02-M-1 540