~NL~d

SENDER:

COMPLETE THIS SECTION

•

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.mailpiece,

or pn the front if space permits.

1.

ArticleAddressedto:

10/21/04

A~~—032

Rosemary

Pehm

1

.~State Route

29

IL

61527

B7/

RECE~VED

CLERK’S OFFICE

NOV 03

2004

STATE OF ILLINOIS

Poflution Control Board

A:Signature

:x

~ Rg

~

C.D~

7

De~

0.

Is delivery

address d

re

t from

item 1?

0

Yes

If YES, enter delive~

adftress below~

0

No

3.

Service-Type

ertified Mail

Registered

0

Insured Mail

O

Express Mail

o

Return

Receipt for Merchandise

o

C.O.D.

4.

Restricted Delivery? (&t,a

Fee).

0

Yes

2.

Article Number

.

-

(Transfer

from

s~rvice

label)

7004

1160

0005

4126

3929

PS’Fomi3Bi

1,

February 2004

-

DothesticRetürn Receipt

102595-02-M-1540