SENDER:
    COMPLETE THiS SECTION
    •
    Complete items 1, 2,
    ahd 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:
    4/22/05
    AC 2005—027
    Leonard Harris
    13011 0ffice~Drive
    Poplar Grove,
    IL
    61065
    RECE~VED
    CLERK’S OFFICE
    APR 29
    2005
    STATE OF ILUNOIS
    Pollution Control Board
    A.
    Signat
    re
    ~
    B.
    Receiv
    by
    (Printed Name)
    C
    Date of
    Delivery
    II
    rri’~
    4’~2~
    D.
    is delivery address different fmm item 1?
    0
    )~es
    If YES,
    enter delivery address below:
    0
    3~Service Type
    ~Certified
    Mall
    o
    ExpressMail
    o
    Registered
    0
    Return
    Receipt for Memhandise
    o
    Insured Mail
    0
    C.O.D.
    4~Restricted
    Delivery?
    (Extra
    Fee)
    2.
    Article Number
    (Thansferfrom seMce label)
    -
    7004
    Domestic
    2890
    Return
    0004
    2296
    4755
    Receipt
    102595-02-M-1540
    0
    Yes
    PS
    Form 3811,-February 2004

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