SENDER
    COMPLETE
    THIS SECTION
    •
    Con~pIete
    items 1, 2, and 3. Also complete
    item 4 if Res~tricted
    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 mailpiece,
    or on the front if space permits.
    1.
    ArticleAddressed to:
    6/16/05 B.M.
    PCB
    2005—205
    Dan Young
    RR2, Box
    86
    Sumner,
    IL 62466
    RECE~VED
    CLERK’S OFFICE
    JUN
    27
    2005
    STATE OF ILLINOIS
    Pollution Control Board
    A.
    ature
    ~/!/~L~f
    A
    ressee
    ‘6.
    eceivecI’by~Pdnted
    Name)
    ~
    DatL~~eJivery
    \(l~L~OU~f
    (e-a~o~$
    D.
    Is delivery address di
    erent
    em
    1?
    0
    Yes
    If YES, enter delivery address below:
    0
    No
    3.
    Spvice Type
    ~-~ertified
    Mail
    o
    Registered
    o
    Insured Mail
    I
    o
    Express
    Mail
    o
    Return
    Receipt for Merchandise
    o
    C.O.D.
    :
    4.
    Restricted Delivery?
    (Extra
    Fee)
    0
    Yes
    2.
    Article Number
    (Transfer from sen/ice
    label)
    7004 2890
    0004
    2307
    1193
    PS Form
    3811,
    February 2004
    Domestic Return
    Receipt
    102595-02-M-1540

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