CLERFcS

OFF!CE

OCT

1 ~

2004

STAi~

OF ILLINOIS

PoIIu~0~

Control Soard

SENDER:

COMPLETE

THiS SECT/ON

U

Complete items 1, 2, and 3. Also complete

item 4

if Restticted.Delive~,is desired~

I

Print your name and address on ‘the reverse’

so that we can return the

card

to yoU.

•

Attach this card to theback-ófihe.mailpiece,

•or on the front if space’ permits.

PCB

2005—001

Article

Addressed to:

10

/

7

/

04

Matthew

M.

Klein

322

West

Burlington

LaGrange,

IL

60525

4.

.Restricted Delivery?

(Extia Fee,l.

0

Yes

~_________________________________________________

2.

Article Number

(Transfer

from

sèMceIabef)

7004

1160

0005

4~1~26

3868

/

B.M.

SetviceType

‘t~~ertlfied

Mall

‘0

Registered

o

Insured Mail

O

Express

Mall

0

RetUrn Receipt for Merchandise

O

C~O.D.

PSForm’381 1, FebruaIy2004

Dorpestic RetUrn Redeipt

102595-02-M-1540