REC~VED

CLERtcS OFFICE

SEP 152004

STATE OF ILLINOIS

POIIutj~nControlBoard

1’.•

SENDER:

COMPLETE THIS SECTION

• Complete items 1, 2, and 3. Also complete

item 4 if Restricted Delivery is desired.

U

Print your name and address on the reverse.

so that we can return the card to you.

U

Attach this card to the back of the mailpiece,

or on the front if space permits.-

1. Article Addressed to: 9 / 2/04 B • M.

PCB 2005—038

Randall Leman

Lone Willow USA, Inc.

1389

County Road 1600 N

Roanoke, IL 61561

/

A. Signat e

~~

B7~ecelvedby

~1nted Name)

C. Date of Delivery

•

D~Is deliveryaddress differentTmn~item 1? 0 Yes

If YES, enter delivery address below:

0 No

3. S~rvlceType

~ertifled Mail

~ Registered

0 Insured Mail

o Express Mall

O Return ReceIpt for Menthth~dise

0 C.O.D.

4. Restricted Delivery?

(Ekts~Fee)

~

2~Article

Number

(Tran~ferfromsen4ce

IabeO

7004 1160.0005 4123 1508

PS FOrm 3811, February .~OO4

Ogmestic Retum~Receipt

1ô259s~o2~M-154O

~1