SENDER:
    COMPLETE THIS SECTION
    COMPLETE THIS SECTION ON DELIVERY
    •
    Complete items
    1, 2, and 3. Also complete
    A.
    Signature
    0
    Agent
    item
    4 if Restricted
    Delivery is desired.
    x
    ~
    ~—u~,j.k~411~4°
    Addressee
    N
    Print your name and address on
    the reverse
    __________________________________________
    so that we can
    return the card to you.
    B
    nted
    Name)
    C
    Date
    of DeliveW
    • Att~h
    this card to the back of the
    mailpiece,
    ~~ei~ed
    ~
    ~,
    i ~
    or~thefront if space permits.
    If YES,
    enter delivery
    address below:
    0
    No
    1. Arti~Addressed
    to:
    7
    /
    22
    /
    04
    B
    ,~,//
    D.
    Is delivery
    address different from item 1?
    0
    Yes
    AC 2~004—081
    Ralph and Lois Williams
    189
    Kn:ox Road,
    730 N
    Galesburg, IL 61410
    3.
    Service Type
    ~~erttfied
    Mail
    0
    Express Mall
    ‘tJ
    Registered
    0
    Return Recefptfor Merthandise
    0
    Insured Mail
    0
    C.O.D.
    4.
    Restricted
    Delivery?
    (&tre
    Fee)
    0
    Yes
    2.
    ArtIcle Number
    (Transferfrom service label)
    7002 2030 0004 5523 9040
    PS Fbrm~381
    1,
    Aügt~t
    2001
    ~Qomestic
    Return
    Receipt
    102595-02-M-1540
    RECE~VED
    CLERK’S OFFICE
    AUG
    2
    2004
    STATE OF ILLINOIS
    Pollution Control Board

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