SENDER

: COMPLETE THIS SECTION

•

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

.

1

. Article Addressed

0:

10/19/06 B .

AC 2006-050

Mark Gates

323 Decatur Street

Lincoln, IL 62656

QR~uR

E

NOV

R

EIOVED

2006

Pollution

STATE OFControl

ILLINOIS

Board

ffix

COMPLETE

Iva

THIS SECTION

'

ON DELIVERY

D. Is delivery address different from item 1?

0 Yes

If YES, enter delivery address below :

0 No

0 Agent

0 Addressee

C . Date of Delivery

a a -o(.

e Type

MW

Mail

0 Express Mail

R Istered

0

Return Receipt for Merchandise

0

Insured Mail

0 C.O.D

.

4

. Restricted Delivery? (Extra Fee)

0 Yea

2

. Article Number

I

I (rransferfmmsefvlcelabelj

(i7ansler from

servke label)

7005 1160 0 002-

2068 0527

I PS

Form 3811,

February 2004

Domestic Return Receipt

102595-02-M-1540

: