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Complete items
1, 2,
and 3.
Also
complete
item 4
if
Restricted
Delivery is desired.
S
Print
your name
and
address
on the
reverse
so
that we can return the
card to you.
•
Attach
this
card to the bact
of the
mailoiece,
or art
the
front
it
space permits.
1.
?jlrcieoddrsssedto:
10/10/05
B.M.
PCB
2005—095
Jane
F.
Kiassen
The
Jeff
Diver
Group
1749
South
Naperville
Road
Suite
102
Wheaton,
IL
60187
D Agent
-
-
-
OAddresse.
B.
Received
by (Printed Namei
C.
Date of
Deirver-
0.
is
sever, address different fran,
rem
1?
0
Yes
it Yts.
enter dravere
address
Oeiow:
0
No
3.
Service Tipe
rifled
Mail
0
txamsa
Mait
Registered
0
Return
Receipt tar Merchandise
o
Insured Mat
0
0.0.0.
A
x
Signature
4.
Restecoed Detiver5r?
Enva Feet
0
Yes
2,
Arllcte Number
lTraosferfiomson”colabefl
7005
1160
0002
2069
4012
PS Form 3811,
February
2004
Domestic
Return
Receipt
1t2seb-.32-M-
54
SENDER:
COMPLETE
THIS SEC17CJN
COMPLETE TINS
SECTION
ON
ITEIJVERV
•
Complete items
t,
2, and
a.
Atso
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
csrd
to
the back of
the mailpiece.
or
on the front
if space
permits.
‘I.
.ejliae Addressed to:
10/ 20/05
B .M.
PCB
2005—095
Thomas
S.
Yu
The
Jeff
Diver
Group
1749
South
Napervilie
Road
Suite
102
Wheaton,
IL
60187
/
V
2.
Article Number
(I’mnsfhritomservlcelabel)
7005
1160
0002
A.
Signature
x
,
~
S.
eeceivec
by (Printed Name)
‘C.
Dare
at Deliver.
~
0.
Is delivery
address different tram tam
rn
0
Yes
If
YES.
enterdei’vsry
address below:
0
No
3.
Service
Type
-
.rt-titd
Mail
0
Excrete
Mail
Registered
0
Return
Recatpt
for Merctiandiss
0
Insurec
Mail
0
cOD.
4.
Restnar’a
Delivery?
140dm
Fee)
0
Yes
2069
4005
PS
Form
3811,
February
2004
Domestic
Return
Recaipt
1
s2sss’Os’M’r
540
SENDER:
COMPLETE
17115
SECTRill
-
CQMPLEIEI7WS
SECTION
ON
lIEUVERY
•
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.
l.MicieAddressedto-
10/20/05
B.M.
PCB
2005—095
Michael
S.
Blazer
The
Jeff
Diver
Group
L749
South
Napervilie
Road
Suite
102
Wheaton,
IL
60187
2.
Mlcle Number
77
2-’
A,
Signaicfle
/fl
7
x
v~~.çJ”~3
0
Agent
0
Addressee
3.
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by(Printed
Name)
C.
Dare of Delivery
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0,
is deiserv address ditlerent from
-Irm en
0
Yes
IfYES,
enterdelivery
address beew:
0
No
3.
Sensce
Type
,~Carth1edMat
0
Expresa
Mat
O
RegIstered
0
Retum
Receipt ftr Merchandise
0
Insured Mall
0
0.0.0.
4.
Restncted Delivery?
lExrm
Feel
0
Yes
(Tmnsferfmmsenvlce
label)
7005
L160
0002
2069
3992
ORIGINAL
RECEIVED
CLERK’S OFFICE
NOV
0112005
STATE OF ILUNOIS
pollution Control Board
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PS Form
3811,
February
2004
Domestic Return
Receipt
tt2sas’02’M’1SIO
