REC~VED
CLERK’S OFFICE
JUN
~~
200k
STATE
OF
ILUNOIS
POUUtiOfl
Control Board
a
Complete items
i;
~,anu
,.
Aso
complete
item 4 if. Restricted Delively is
desi~eCL
a
Print yourflame and
address
on.the
reverse.
so
that
we can return thecard toyOU
a
Attach this card~e back ofthe
mailpiecer
fl~Md~W57~7~
AC
2004—056
Jerry HathawaY
~17-S~0akWOOd~
(~)~t2~L
Oakwood,
IL.
1~
:
~
a
Complete items 1
2, and 3
Also complete
Sign
re
I
item 4
if
Restricted Delivety
us
desired
~
‘,
t) ~gen4
a
Printyournameandaclclressonthereverse
~
.
.
•
Attach tl~scardtothe backof
the
n~ailpiece
B
~f,nte~ame)
~~te9e~y~
D.
Isde1ive~addressdifferenf~itern1~.
ayes,’
1
i~irticle
Addressed
to
5
/
6/04
B
M
If
YE&epte~de~iverY
addres~i~eiu~2
Z~
N~
AC
2004—056
Da~i~llCripe
*
1617 4~rrysvilleRoad
1
t~anvi11e,IL
________________________________
.11;
~.
.
..‘
.~•
.
3.seMcr~:~-~
‘-‘~~.:.9:-.~
j
Certified Msil~
0
Expleas Mail
0
9e~isteredi
0
~eturp
Re~eipt
for
Me,~handj~e,
~
~
4
R
1ced
Dellve4
(Extt~
Fee)
0
Yes
2
Article
Number
I
(Tmnsferfvinsepiice~abeO
~7003~
?2(~0
O007~2442t2805~~~
I
~?$
Fqm1
~1
~
August 2001
Domestic F~etum
Receipt
10259502
~,
~
~
i
~
—
.
~7r.;
SENDER:
COMPLETE
THIS SECTION
D.
Is delWeYadckOSS
lS:enterde~~~!
-
H°