ORIGINAL
    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.
    U
    Attach this
    card to the back of the mailpiece,
    or on
    the front
    if space permits.
    1.
    Article Addressed
    to:
    6/2/05
    B.M.
    AC
    2005—067
    /
    RECEIVED
    CLERK’S OFFICE
    JUN
    13
    2005
    STATE OF ILLtNQI$
    pollution Control Board
    ~eceived by
    (Pn#d
    Name)
    (7~
    C.
    Date
    oDe~~’
    D.
    Isdelivery address differentf~m
    Item 1?
    Yes
    If YES, enter
    delivery address below:
    0
    No
    Donald
    E.
    and Mary A.
    Jennings
    R.R.
    4,
    P.O. Box 31
    Mt.
    Sterling,
    IL 62353
    3.
    ServIce Type
    ~CertIfied
    Mall
    O
    Registered
    o
    Insured
    Mail
    O
    Express
    Mall
    0
    Return
    ReceIpt for Merchandise
    o
    C.O.D.
    4.
    RestrIcted
    Delivery?
    (ExtraFee)
    0
    Yes
    2.
    ArtIcle
    Number
    (Iransferfromservice
    label)
    7004
    2890
    0004
    2307
    1025
    PS Form
    3811’,
    February 2004
    Domestic Return
    Receipt
    102595-02-M-1540
    A.
    Signature
    El
    Agent
    ~i~e~i
    D Addressee

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