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.

•

Attach this card to the

back of the mailpiece,

or on the front

if space permits.

1.

Article Addressed to:

417105

B

.

M.

PCB

2005—176

Luke

Brunmier

8047 N.

2lOOth Street

Dieterich, IL 62424

2.

Article

Number

(rransfer from service label)

RECEIVED

CLERK’S OFFICE

APR

18

2005

STATE OF ILLtNOIS

Pollution Control Board

A.

X

Signature

-~J

L~t~)

~yji~

~.J’~~(A//~

TV”

0

Agent

0

Addressee

B.

Received by

(Printed

Name)

C.

Date of Delivery

t4—(c.-t)~

D.

~

d~livery

address

different

from item

1?

0

Yes

If

YES, enter delivery address below:

0

3.

Service Type

?~~ertified

Mail

O

Registered

0

Express Mail

0

RetUrn

Receipt for Merchandise

o

Insured

Mail

0

C.O.D.

4.

Restricted

Delivery?

(Ext,~

Fee)

~J~

7004 2890 0004 2296 4670

PS

Form

3811,

February 2004

Domestic Return

Receipt

102595-02-M-1 540