MAR
    142005
    2.
    Article
    Number
    (Thansfer
    from
    service
    label)
    3~ServiceType
    ~ertif
    led
    Mail
    o
    Registered
    o
    Insured
    Mail
    o
    Express Mail
    El
    Return
    Receipt for Merchandise
    o
    b.o.o~
    RECE~VED
    CLERK’S OFFICE
    STATE OF ILLINOIS
    Pollution Control Board
    SENDER:
    COMPLETE
    THIS SECTION
    COMPLETE THIS SECTION ON
    DELIVERY
    •
    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.
    a
    Attach this card to the
    back of the mailpiece,
    or ~~the front
    if space permits.
    A.
    Signature
    x
    ~Agent
    0
    Addressee
    1.
    Artl~f&Addressed
    to:
    3/3/05
    B .M.
    PdBr2005—o08
    John Ustich
    Village of Capron
    118 4th Street
    Capron,
    IL 61012
    2.
    Arti~
    (Trol
    PS Fo~.
    .~~.
    ~.
    B.
    14’ecped
    by
    (Printed Name)
    J
    C.
    Date of Delivey
    /~t/~/6j71/~11
    ~-1/-O
    ~
    ,p~’1~s
    delivery address different
    from
    item 1?
    ~Yes
    If
    YES, enter
    delivery
    address below:
    0
    No
    P6 fS~
    SIL1~
    IL
    3.
    Service Type
    ~ertified
    Mail
    0
    Express Mail
    o
    Registered
    0
    RetUrn
    Receiptfor Merchandise
    o
    Insured
    Mail
    0
    C.O.D.
    Delivery?
    (Fxtra
    Fee)
    0
    Yes
    02595-02-M-l 540
    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.
    I
    a
    Attach this
    card to the back of the mailpiece,
    -
    or on the front if space
    permits.
    -
    A. Si~yfe
    ‘~4’~-
    ~gent
    x ~
    ~
    I
    tj
    Addressee
    B. Received
    b
    (Printed Name)
    C. nate of De~sry
    8~-~~7~T
    IfO~
    6.
    Is
    delivery
    address
    different
    from
    item
    1?
    0
    Yes
    If YES, enter delivery address below:
    0
    No
    1.
    Article Addressed to:
    3/3/05
    B.M.
    PCB 2005—008
    Robert
    C. Pottinger
    Barrick,
    Switzer, Long,
    Balsley & Van Evera
    P.O.
    Box 17109
    Rockford,
    IL 61110—7109
    4.
    4~
    Restricted
    Delivery?
    (Extra
    Fee)
    7~04~2~00Q~4
    2296 1013
    0
    Yes
    PS Form 3811,
    February 2004
    Domestic Return
    Receipt
    102595-02-M~1540

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