SENDER : COMPLETE THIS SECTION

∎ Complete items 1, 2, and 3 . Also

complete

j

Item 4 If Restricted Delivery is desired .

∎ Print your name and address on the reverse

j ∎ Attach

so that

this

we can

card

return

to thethe back

card

of

to

the

youmallpiece,

.

or on the front If space permits.

1 . Article Addressed to

5/18/06 B .M .

AC 2005-063

John R . Malloch

j 2572 County Road 600E

Dewey, IL 61840

I

2 . Article Number

(Transferfromservice)abeq

7005 1160 0002 2067 9255

1

PS

Form

3811,

February 2004

Domestic Return Receipt

D

. Is delivery address different from Item 1T

Yes

It

YES, enter delivery address below

:

O

No

4 .

ce type

ad Mall 0 Express Mall

Registered

0 Return Receipt for Merchandise

0 Insured Mall

O C.O.D

.

Restricted Delivery? (Sue Fee)

RECEIVED

CLERK'S OFFICE

MAY 3 1) 2006

STAT

OF ILLINOIS

Polluti n

In r

rp $ .I

COMPLETE THIS SECTION ON DELIVERY

A Signature

x

dYUQ

N ~e

00AgentAddressee

B . Received by (Printed Name)

C . Oat

De ery

0 Yes

102595-02-M-1540