ORIGINAL
    RECE~V~D
    CLERK’S OFFICE
    JAN
    212005
    STATE OF
    ~LL~NO~S
    PoHut~on
    Controi
    Board
    •
    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 mailpiece,
    or on the front
    if space permits.
    1.
    ArticleAddressed
    to:
    1/6/05
    B .M.
    PCB
    2005—120
    & PCB 2005—121
    John
    S.
    Swearingen
    Marathon Ashland Petroleum
    Refinery Office Building
    Robinson,
    IL 62454
    V
    A. ~nature
    xL~i~u~3~
    ~
    2~ssee
    B.
    R
    ceived by
    (Printed Name)
    C.
    Date of Delivery
    •~
    Is delivery address different from
    item 1?
    0
    Yes
    If YES, enter delivery address below:
    0
    No
    3.
    Service Type
    ~Certified
    Mail
    0
    Express Mail
    o
    Registered
    0
    Return Receipt for Merchandise
    o
    Insured
    Mail
    0
    C.O.D.
    4.
    Restricted
    Delivery?
    (Extra Fee)
    0
    Yes
    (rransfer from service label)
    7004
    0750
    0004
    3960
    2410
    SENDER
    COMPLETE THIS SECTION
    COMPLETE THIS SECTION ON DELIVERY
    2.
    Article Number
    PS
    Form
    3811,
    February 2004
    Domestic Return
    Receipt
    102595-02-M-l
    540

    Back to top