SENDER:
    COMPLETE THIS SECTION
    •
    Complete items 1, 2, and 3. Al~o
    complete
    item
    4 if Restricted Delivery is de~ired~
    •
    Print your riafne and addyess on the reverse
    so that we can return the card tb-you.
    U
    Attach this card to the back of the mail~iece,
    oron
    The front if space permits.
    f.
    Article Addressed
    to~
    11/4/04
    B
    .M.
    PCB
    2005—067
    John F.
    Nocita
    734 N. Wells
    Chicago,
    IL 60610
    CLEAK’S
    OFF,C~
    NOV
    12
    2004
    SThTE OF ILLINOIS
    Poiiut~
    Control Board
    I
    /,~
    Sign
    re
    x
    ~
    D~ent•
    B.
    Received by
    (P,infedNthme)
    -
    D.
    Is delivery address different
    frcrn item
    .
    0
    es
    If YES, enter delivery
    address
    below:
    0
    No
    3.
    Service 1~pe
    •
    ~jertified
    Mall
    o
    Registered
    o
    Insured Mall
    o
    Express
    Mall
    o
    Return
    Receipt for Merchandise
    .0
    C.O.D.
    4.
    Restricted
    Delivery?
    ~Ektra
    Feel
    D.Y~s
    2
    Article
    Number
    ansferfromser,Icelaba9
    •.,
    7004
    1160
    0005
    .
    4124
    ,
    9671
    .
    .
    .
    •PS Form
    3811,
    February 2004
    Dortlestic Return
    Receipt
    lO2~95-O2-M-154O

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