SENDER

COMPLETE THISSECTION

U Complete items 1, 2, and 3. Also complete

item 4 if Restricted Delivery is desired.

N Print your name and address on the reverse

so that we can return the card to you.

N Attach this card to the back of the mailpiece,

or on the front if space permits.

1. ArticleAddressedto:

2/3/05 B.N.

PCB 2005—134

Lewis Properties, LLC

4289 Bible Grove Lane

Louisville, IL 62858

V

/

RECE~VED

CLERK’S OFFICE

FEB 2 2 2005

STATE OF ILlINOIS

Pollution Contra) Board

A.

Signature

I

X

~

(J~

I~_

y(Received by

(Printed

Name)

~

0

Agent

0 Addressee.

C. Date of Delivery

/7~of

D. Is delivery address

different from

item 1? 0 Yes

If YES, enter delivery address below:

0 No

3. Service Type

~?ertified

Mail

-D

Registered

o Insured Mail

o Express Mail

o Return Receipt for Merchandise

o C.O.D.

.

4. Restricted Delivery?

(Extra Fee)

0

Yes

2. Article Number

(rransferfromservice•Ia~5el)

7004 0750 0004 3960 2649

PS Form

3811,

February 2004

Domestic Return Receipt