REC~VED
    CLERK’S OFFICE
    MAR
    142005
    STATE OF ILUNOIS
    Pollution
    Contro’ Board
    SENDEl~:
    COMPLETE THIS SECTION
    COMPLETE TillS SECTION ON
    DELIVERY
    •
    Complete items 1,
    2,
    and 3. Also complete
    item
    4
    if Restricted
    Delivery is desired.
    I
    Print your name and address on
    the reverse
    so that we can return the card to you.
    I
    Attach this card to the back of the mailpiece,
    or on the front if space permits.
    1.
    Article Addressed to:
    3/
    305
    B
    N.
    PCB 2005—078
    Ralph Stone, Mayor
    Village
    of Gorham
    404 North Adams Street
    Gorham,
    IL 62940
    o
    Express
    Mail
    o
    Return
    Receipt for Merchandise
    D.C.O.D.
    4.
    Restricted
    Delivery?
    (Extra Fee)
    0
    Yes
    2.
    Article
    Number
    (rransferfrom service label)
    7004
    2890
    0004
    2296
    1037
    PS
    Form
    3811,
    February 2004
    Domestic Return
    Receipt
    10259&02-M-154O
    A~
    nature
    o
    Agent
    o
    Addressee
    /
    If.YES, enter delivery addre~
    3.
    Spvice Type
    ~~Certified Mail
    ti
    Registered
    0
    Insured Mall

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