RECE~VED
CLERK’S
OFFICE
FE~072005
STATE OF ILIJNOIS
Po~tutionControl Board
ORIGINAL
SENDER:
COMPLETE THIS SECTION
COMPLETE THiS SECTION ON
DELIVERY
•
Complete items
1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
a
Print your name and address on the reverse
so that we
can return the card to you.
a
Attach this card to the back of the mailpiece,
or on
the front if space
permits.
A.
Signature
x-~7~
B. R~~ved
by
P intedNa~pef’
)/gL(~~~g~
MiX’
O Agent
o
Addressee
D. I~
delivery addressdifferent fmm item 1?
0
Yes
If YES, enter delivery address below:
0
No
C.
Date
of D~èIiv~y
1.
ArtipleAddressedto:
1/20/05
B.M.
AC
2005—036
John Narmont
209 Bruns Lane
Springfield, IL 62704
2.
Article!
(Transul
~s
Forrr~
3.
Service Type
o
Certified Mail
o
Registered
o
Insured Mail
o
Express Mail
o
Return
Receiptfor Merchandise
o c.o.o.
4.
Restricted Delivery?
tExtra
Fee)
.0 Yes
595-02-M-1540
