CLERK’S OFFICE
    NOV
    29
    2004
    STATE OF ILlINOIS
    Pollution
    Control Board
    SENDER:
    COMPLETE
    THIS SECTION
    COMPLETE THIS SECTION ON DELIVERY
    •
    Complete items 1, 2,
    and 3. Aléo
    complete
    item
    4 if Restricted Delivery is deCired.
    •
    Print your name and
    address on the revers~
    so that we can return the card tb-you.
    U
    Attach this card to the
    back of the mailpiece,
    or on the front if space permits.
    i.
    ArticleAddressedto:
    11/18/04
    B.M.~,,,1/’
    AC
    2005—030
    Doug
    & Theresa Christison
    600 Green Street
    Barry,
    IL 62312
    A
    Signature
    ~
    o
    Agent
    o
    Addressee
    -
    B.
    Re
    ~
    —-.~—--..—-—
    —~-~--——
    cei~d
    by
    (PrintedName)
    .
    .
    C.
    Date Of Delively
    1’L~i~’
    -
    D.
    Is delivery address different fI’om
    item 1?
    U Yes
    If YES, enter delivery address below:
    0
    No
    3.
    Spvice
    Type
    ‘~CertifiedMail
    -
    o
    Registered
    0
    Express Mail
    0
    Return
    Receipt for Me~chandise
    O
    Insured Mail..
    0
    C.O.D.
    -
    4J
    Restricted
    Delivery?
    (Ektra
    Fee)
    DYes
    .2; ArtIcleNumber
    nscrfromsencelaeel,J
    .
    7004
    ,
    0750
    .
    0004
    3960
    1796
    PS
    Form
    3811,
    February
    2004
    •
    Dotriestic Return Receipt
    1O2~95-O2-M-154O

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