ORIGINAL

•

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 caiti to the

back of the mailpiece,

or on the front if space permits.

I.

ArtlcleAddressedto:

10/6/05

B.M.

AC 2006—005

Debbie Melvin

1464 North Division

DuQuion,

IL

62832

STATE

Pollution

OCT

2005

SENDER:

COMPLETE

THIS SECTION

COMPLETE THIS SECTION ON

DELIVERY

A.

Signature

Q

~tt~k

0 Agent

_________

rj,1&_~o

Add

B.

Received by

(Printed

Name)

C.

Date

I

Del

ery

~

I

~p

i~

/°~ur

prldelivew

address different from

item

I?

0

Yes

It YES, enter delivery address below:

El

No

3.

Servicel~pe

med Mall

0

Express

Mail

Registered

0

Return

Receipt for Merchandise

0

Insured Mall

0

COD.

4.

RestrIcted Delivery? (Extra

Fee)

0

Yes

2.

ArtIcle

Number

(Transferfmmser4celabeQ

7005

1160

0002

2069

3763

PS Form

3811,

February 2004

Domestic Return

Receipt

102595-02M-1540