SENDER:

COMPLETE THIS

SECTION

•

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.

NticleAddressedlo:

8/4/05

B.M.

AC

2005—079

Richard Lee

& Penny

E.

Tedrow

Rural Route

1

P.O.

Box

61

Baylis,

IL 62314

ORIGINAL

RECEIVED

CLERK’S OFFICE

AUG

1

~2OO5

STATE OF ILLINOIS

PoIufloncontroj

Board

A.

Si

atur

X

~

I

~

Agent

~jq

S1

o.~Jja~t,J

0

Addre

B.

Received

by

(Printed

Name)

C.

Date

I Dervery

rA,’~x-

delivery address different from

item 1?

C

Yes

If

YES, enter delivery address below:

0

No

—

a.

Se

eiype

certified

Mail

0

Express Mail

C RegIstered

C Return

Receipt for Merchandise

C

Insured Mail

0

COD.

L

4.

Restricted

Delivery?

Extra

Fee)

0

Yes

2.

Article Number

.

fftansfertrom service labei)

7004 2890 0004 2307

1506

PS

Form

3811,

February 2004

Domestic Return

Receipt

102595-O2-M~154O