cM~~
L~L
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.
M
Attach this card to the back
of the mailpiece,
or on the front if space permits.
1.
ArticleAddressed to:
2/17/05
B.M.
PCB 2005—153
Richard Harmet
1332 1100 East Road
Cropsey,
IL 61731
RECEIVED
CLERK’S OFFICE
FEB
28
2005
STATE OF ILLINOIS
PoIlut~0flControl Board
A.
Signature
x(~e~i__
~~Z&d
B.”fl~eived
by
(Prf
ted
e)
C.
Date of Delive~
J~41
~
2—25~2~
D.
Is delivery address different from
item 1?
0
Yes
If YES, enter delivery address below:
0
No
3.
Seo,ice Type
~~CertifiedMail
4J
Registered
0
Express Mail
0
Return
Receipt for Merchandise
0
Insured Mail
0
COD.
SENDER
COMPLETE
THIS SECTION
COMPLETE
THiS
SECTION ON DEL1t’ERY
o
Agent
o
Addressee
V
2.
Article
Number
(Transfer fl-cm seMce label)
4.
Restricted
Delivery?
(&tra Fee)
0
Yes
7004 2890 0004 2296 0931
PS
Form
3811,
February 2004
Domestic Return Receipt
I o2595-02-M-I540