CLERK’S OFFIU~

AUG

~12035

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.

I.

Asticle Addressed to:

8/18/05

B

.M.

AC

2004—063

&

AC

2004—064

Egon

Kamarasy

474

Egret

Lake

Ri

Carbondale,

IL

j

r4.~jfl~faEvI.j~1fc.1s’ywv.T~vItv

A.

g

re

C Agent

DAddressee

s/Received by

(Printed

Name)

C.

Date of Delivery

/

0.

Is delivery address different from

item I?

0

Yes

If YES,

enter delivery address

below:

3

No

3.

Sepice Type

rtified Mail

0

Express Mail

RegIstered

0

Return

Receipt for Merchandise

0

Insured Mail

0

COD.

4.

Restricted

Delivery? (En~

Fee)

C

Yes

2307

1551

ORIGINAL

STATE OF ILLINOIS

Pollution Control

Boara

2.

Micle Number

ffransferfromsen4ce/abel)

7004

2890

0004

PS Form

3811,

February 2004

Domestic Return

Receipt

102595-02-M-154o