REC~1VED
    0 R
    I G
    IN1A L
    CLERK’S OFFICE
    JAN
    202005
    STATE OF ILUNOIS
    Pollution Control Board
    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.
    Article Addressed
    to:
    1/6/05
    B.M.
    AC
    2005—035
    Greg Ingle
    P.O. Box 407
    Wataga,
    IL 61488
    C.
    Da’te~pfDelivery
    -)~
    -oq
    D.
    Is deliv~ry
    address~different
    from item
    1?
    If YES, enter delivery address below:
    D
    Yes
    0
    No
    3.
    Service Type
    ‘~Certified
    Mail
    0
    Express Mail
    O
    Registered
    0
    Return Receipt for Merchandise
    o
    Insured Mail
    0
    C.O.D.
    4.
    Restricted
    Delivery?
    (Extra
    Fee)
    0
    Yes
    2.
    Article Number
    (rransfer from service
    label)
    7002
    0750
    0004
    3960
    2304
    PS Form
    3811
    February 2004
    Domestic Return
    Receipt
    102595-02-M-1540
    A.
    Sig
    ture
    x
    B. Received
    Jfrinted
    Name,)
    6v~g
    Ir~c~i(’
    U
    Agent
    ~
    ~Addressee

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