i—’~
    ~i
    ;~
    ~
    \l
    /~
    U1\
    U
    \Ir\L
    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.
    Article
    Addressed
    to:
    1
    /
    6
    /
    05
    B
    .
    M.
    //7
    AC 204—084
    Roger Kinney
    101
    South Broadway
    Salem,
    IL 62881
    2.
    Article Number
    (rransfer from service label)
    CLERK’S
    OFFICE
    JAN
    1 ~
    STATE OF ~LUNOIS
    F~o~1UtiOfl
    ContrOi
    Board
    D.
    Is delivery address different from
    item 1?
    0
    Yes
    If YES,
    enter delivery address below:
    0
    No
    SENDER
    COMPLETE THIS SECTION
    COMPLETE THIS SECTION ON
    DELIVEHY
    A.
    Signature
    --
    -
    o
    Agent
    o
    Addressee
    B. Re~ived
    ~
    by
    (Printeçi
    Name~
    ~
    c.
    pate of Delivery
    f-H~o~
    3.
    Service
    Type
    ~~1~ertified
    Mail
    o
    Registered
    o
    Insured Mail
    0
    Express Mail
    0
    Return
    Receipt for Merchandise
    0
    C.O.D.
    4.
    Restricted
    Delivery?
    (Extra
    Fee)
    0 y~
    7004 0750 0004 3960 2267
    PS Form
    3811,
    February 2004
    Domestic Return
    Receipt
    102585-02-M-1540

    Back to top