ORIGINAL

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 on the front if space permits.

1. ArticleAddressedto:

12/16/04 B.M.

PCB 2005—075

Michelle D. Jordan

7750 S. Hoyne

Chicago, IL 60620

/

E CE ~iV ~ED

CLERK’S OFRCE

DEC

27 2004

STATE OF ~LUNO~S

Po~utionContro’ Board

A. Signature

-

~-

)~/

-

~

~-,

DAgent

0 Addressee

B. Received by

(Printed Name)

C. Date of Delivery

0.

Is

delivery address differentfrom item 1? 0 Yes

If YES, enter delivery address below:

0 No

3. Service Type

~..Qertif

led Mail

tJ Registered

0 Insured Mail

0 Express Mail

0 Return Receipt for Merchandise

0 C.O.D.

4. Restricted Delivery?

(Extra Fee)

0 Yes

2. Article Number

frransfer from service label)

7004 0750 0004 3960 2199

PS Form 3811, February 2004

Domestic Return Receipt

102595-02-M-1540