ORISINAL

SENDER : COMPLETE THIS SECTION

I ∎ 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 .

1 ∎ Attach this card to the back of the mallplece,

or on the front If space permits .

1 . Article Addressed to:

5/4/06 B .M .

PCB 2004-106

j

Leona Childress

13493 East 6000 South Road

I Saint Anne, IL 60694-4571

I

2

.

Art

I

(Tram

IPASFon,

COMPLETE THIS SECTION ON OELIVEHV

A

. Signature

0 Agent

0 Addressee

B. Received by (Printed

Name)

C .

a Delivery

Is

delivery address different horn item

S

I?

ft

O Yes

0

6

If YES, enter delivery address below :

0 No

RECEIVEDCLERK'S

OFFICE

Ki"t 2

2006

Pollution

STATE OF

Control

ILLINOISBoard

ce 7ype

Melt O Express Mail

Registered

0 Return Receipt for Merchandise

OInsured

Mall ^O

C .O

.D .

O

Yes

259502-M-1500