12- Article Number

(Transfer from servIce label)

PS Form

3811,

February 2004

7005

1160

0002

2068

0510

Domestic Return Receipt

REC EIVED

NO`S 0 c

2006

STATE OF ILLINOIS

pollution Control Board

COMPLETE THIS SECTION ON DELIVERY

SENDER

: COMPLETE THIS SECT/ON

∎

∎

Print

Complete

item 4

your

if

Items

Restricted

name

1,

and

2,

Dell

address

and

very

3-Ion

Alsos

desiredthe

completereverse

.

∎ Attachtthis

card to

we can

or on the front if space

the back

permitsof

.

the mailpiece,

1

. Article Addressed to

:

AC

2006-050

10

19

06

B .

(Mark Kingsley Lewis

1

323 Decatur Street

Lincoln, IL 62656

B Received by (Pdnred Name)

A Sig

re

7C

j-'-0 AgentO

1

Addressee

C Date of

D

. Is delivery address different from ftem 1?

O

O

Yes

If YES, enter delivery address below

:

0 No

0 Yes

Delivery

3

. Service Type

( O

Registeredrtifled

Mall

O

Express Mail

D

Insured Mail

Return Receipt for Merchandise

CJ

C .O.D.

4

. Restricted Delivery? (Extra Fee)

102595

.

02-M-1590