•
‘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
maUpiece,
or on the frent
if space
permits.
1.
ArticleAddressedto:
7/8/04
B.M.
AC
2003—021
Twilla
Williams
Smith
0.
is’d’etvery address
dfferentfmm item 1?
0
Yes’
If YES, enter delivery
address
beow~
3. S~ice
Type.
~4eiti~ied
Mail
‘D
Express
Mall
O
Registered
D
Return
Receipt for
Moivhandlse
O
Insured
Mail
0
0.0.0.
.:‘
t
RestdctedDeUvery1~ExUaFee)’
Dyes
2
Article
Numbar
(Tmnsfepfrom~sn4ceiabeI1
~70O2
2030
0004
5523
~906
a
PS~Fdrm
8811
~ug~
2ÔOf
‘,
DbrWedI~letnReceip~
RECE
WED
CLERK’S OFFICE
JUL
2
92004
STATE OF ILLINOIS
Pollution Control Board
SENDER:
COMPLETE THIS SECTION
COMPLETE THIS SECTION ON
DELIVERY
ignature
xj~g~
Name)
~
~
~Ageat
‘0
Addressee
C.
Date
of Delivery
7-i7-o~
John Smith
201
Grand
Anna,
IL 62906.’
-~
1O2595~O2-M-154O
