ORIGINAL

SENDER:

COMPLETE THIS SECTION

• Complete items 1,2, and 3. Also complete

item 4 ii 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.

I, NticleAddressed to:

8/18/05 B .M.

AC 2005—080

Trust #10897

Sbtith Holland Trust & Savings

Bank

RECEIVED

CLERK’S OFFICE

AUG

2 62005

STATE OF ILLINOIS

Pallution Controj

Boara

r.c.I~h1ff*tpt:I~t1~na.hrf.My.J4Il’fl:f

AB. Si7~g~Received

by

(Printed

4_7

Name)

C. Date at Delivery

D. Is delivery address different from item 1? 0 Yes

If YES, enter delivery address below:

Ci No

3. Service Type

e-~QertifledMail

0 Express Ma~

Ti Registered

0 Return Receipt for Merchandise

0 Insured Mail

0 C.O.D.

4. Restricted Delivery?

(Extra

Fee)

0 Yes

16178 S. Park Avenue

South Holland, IL 60473

2. Article Number

(rransrerrmmse,vrce/abe?)

7004 2890 0004 2307 1582

PS Form

3811,

February 2004

Domestic Return Receipt

102595-02.M.1 540