CLERK’S OFFICE
    ORIGiNAL
    DEC
    2 2
    2004
    STATE OF ILL1NO~S
    Pollution
    Contro’
    Board
    SENDER
    COMPLETE THIS SECTION
    COMPLETE THIS SECTION ON
    DELIVERY
    M
    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 on the front if space permits.
    1.
    ArticleAddressedto:
    12/2/04
    B.M.
    AC
    2004—034
    Troy Williamson
    19022 Buysse Road
    Coal Valley, IL 61240
    4.
    Restricted
    Delivery?
    (Extra
    Fee)
    2.
    Article Number
    (rransferfrornseniicelabel)
    7004
    0750
    0004
    3960
    1888
    PS Form
    3811,
    February 2004
    Dome
    stic
    Return Receipt
    102595-02-M-1540
    3.
    S,rviceType
    fl.Pertified Mail
    0
    Express Mail
    o
    Registered
    0
    Return
    Receipt for Merchandise
    0
    Insured Mail
    0
    C.O.D.
    0
    Yes

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