N~
~l
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
can return the card to you.
a
Attach this card to the back of the mailpiece.
or on the front if space permits.
1.
ArticleAddressedto:
8/5/04
B.M.
PCB
2005—010
Bruce
Batty
1 14928
E. Eddy Road
Davis Junction, IL
RECE~VE~
CLERK’S OFFICJE
AUG
16
2004
STATE OF ILLIWU~.:
Pollution Contro’
bt~~i
A.
Signature
~
~
DAcklressee
B.
R
eived by
(Pn’ntedNanie)
C. Da~
of Delivery
/~e~n,e
~t~rr~i
J1
61020
D.
Is delivery
addi~ssdifferent~m
item 1?
0
Yes
If YES
enter delivery address below
0
No
3. S~ce
Type
ertifled
Mad
0
Express Mail
0
Registered
0
Return Receipt for Meithandise
0
Insured
MalI
0
C~O~D.
4
Restncted Delivery?
(Extra
Fee)
0
Yes
2
Article
Number
(rransfer from seMce label)
7004
1160
0005
4126
3004
PS F~orm
381 1~
~eb~uary
2004
Dohiestic Return ReceIpt
102595 02
M~54o
/
,1
I~
~III
~
~
~
a
Complete Items i,2,and
3.
Also
complete
item
4 if
Bestncted
Delivery is desired
I
•
Print your name and address on the reverse
I
so that we can
return the card to you
•
Attach this card to the
back of the mailpiece
or on
thefront
if space permits
1
ArticleAddressedto
8/5/04
B
M
IPCB 2005—010
Dennis Eugene Batty
14758. E. Eddy Road
Davis Junction,
IL 61020
3.
S9jvice Type
.i~ertified
Mail
El
Express Mall
‘t
Registered
0
Return Receiptfor Meri~handuse
flJnsured MdlI.
0 c.o:o.
4
Restncted Delivery?
(Extra
Fee)
0
Yes
REC~V~
CLERK’S OFFICF
AUG
16
2004
STATE OF iLLt~~1~
P~JI~tj~~
Controg
BOarr~
A.
Signature
X
~
&~2~
0
Addressee
B. Rec4~d
by
(Printed
C.
Date of
Delivery
D.
Is delivery address
different
from
item
1?
0
Yes
If YES, enter delivery address below:
0
No
2.
Article
Number
(rrahsferfçornservicelabe!)
7004 1150 0005 4126 3011
PS Form
3811,
February 2004
Domestic~R~turn
ReceIpt
1o2595~o2-M-154o
