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    THIS SECTION
    •
    Complete items 1, 2, and 3. Also complete
    item
    4 if Restricted Delivery is desired.
    •
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    or on the front if space permits.
    1.
    Article
    Addressed
    to:
    7/8/04
    B.M.
    AC
    2003—013
    John Grivetti
    Box 251
    V
    ~‘
    ent
    ~~gtur~~
    ‘~~~dress,
    nted
    ~j~7~)
    I~Date~Sf
    Delive
    ~
    D.
    Is delivery address different frem
    item
    1?
    0 Ye~~-
    If YES, enter delivery address below:
    0
    N&)
    3.
    Service Type
    ~Q~ed
    Mail
    Registered
    0
    Insured Mali
    4.
    Restricted
    Delivery?
    (&tm Fee)
    0
    Yes
    2.
    Article Number
    (T,snsferfrom service label)
    7002 2030 0004 5523 8890
    ~
    PS
    Form
    3811,
    August
    2001
    Domestic Return
    Recei
    t
    CLERK’S OFFICE
    JUL
    19
    2004
    STATE OF ILLINC~
    Pollution Control E~::
    Wenona, IL 61377
    o
    Express
    Mail
    o
    Return
    Receipt for Merchandk
    o
    C.O.D.
    1O2595-O2-M-1~

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