CLERK’S OFFICE
OCT
2
92004
STATE OF ILLh~OiS
Pollution
Control
6o~r,-~
1.’
ArticleAddressedto:
10/21/04
B.M.
I PCB 2004—015
Kurt J.
Iorberg
Telleen,
Braendle, Horberg
&
Smith P.C.
124 West Exchange Street
P.O. Box 179
Cambridge,
IL 61238
A.
“
Signature
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Agent
DAddressee
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by
(Prin’
71
Name)
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C.
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3.
S9~vice
Type
ertified
Mail
Registered
0
Insured Mail
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Express
MaH
o
Return Receiptfor Merchandise
o
C.O.D.
4
Restncted Delivery?
(Extra
Fee)
DYes
2~Article NJumbér
(rransferfromse,vice!abel)
70041160
0005
4126
3974
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
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frem
item
il
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Yes
If YES, enter delivery address below:
0
No
PS Form 38~
1,
February
2O04
Domestic Return
Receipt
1Q2595-O2-~1~4O