\~L~
    ~
    SENDER:
    COMPLETE THiS SECTION
    I
    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 cart r~tuXn
    the card to you.
    •
    Attach this card to the back of the mailpiece,.
    c~r
    on the front if space permits.
    1.
    ArticleAddressedto~
    2/17/05
    PCB
    2005—151
    John and Ann Beckman
    10951 N.
    1950th St.
    B
    .
    M,7
    RECEIVED
    CLERK’S OFFICE
    MAR
    -32005
    STATE OF ILLINOIS
    Pollution Control Board
    A.
    Signet
    ~
    0
    Addressee
    ~ecelved
    by
    (Printed
    Name)
    .
    C.
    Da
    of
    elivery
    I).
    Is
    delivery
    address
    different
    from item 1?
    0
    Yes
    If YES, enter delivery address below:.
    0
    No
    Dieterich,
    IL
    62424
    .3.
    S~Mce
    Type
    ~ertlf
    led Mail
    0
    Express
    Mail
    ,D
    Register~d.
    0
    Return Receipt for Merchandise
    0
    Insured
    MalI
    0
    C.O.D.
    4.
    Restricted Delivery?
    (Extra
    Fee)
    D~Yes
    2.
    Article
    Number
    (rransferfrornserilce/abel)
    7004 2890 0004 2296 0917
    PS: Form 381
    1,
    February
    2004..
    ..
    DomeCtic Return Recelpt.~
    102595-02-M-1 540

    Back to top